Company name
Humana Inc.
Location
Montpelier, VT, United States
Employment Type
Full-Time
Industry
Bluecollar, Healthcare
Posted on
Nov 01, 2022
Profile
Description
Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues.
Responsibilities
There are 4 shifts available for this role. All are M-F with rotating weekends (every 3rd-4th Sat & Sun)
8:30AM to 5PM ET
11:15-7:45PM ET
12:30PM to 9PM ET
2:30PM to 11PM ET
*12% shift differential pay starting at 6PM
Essential Duties and Responsibilities:
Assist in setting up and maintaining hospice/facility/pharmacy relationships under the direction of the Pharmacy Claims Team Leaders & the Pharmacy Claims (Support Services) Manager
Assist pharmacies with claims adjudication
Complete incoming tasks as assigned by the Pharmacy Claims Team Leaders and the Pharmacy Claims (Support Services) Manager
Obtain all necessary information for facilities and their related pharmacies
Assist the Call Center management team with projects to enhance the workflow and success of the Call Center
Assist Customer Service team with claims research/resolution
*Assist with new hires training
RESPONSIBILITIES (include but are not limited to):
Billing:
Assist pharmacies with claims adjudication by adjusting/correcting authorizations in dispensing systems and PBM systems
Ensure timely adjudication of prescription claims through PBM systems
Contact hospices for authorizations/approvals for submitted claims where necessary
Ensure accuracy of patient profile data including related/not related status, authorization status, etc
Research and correct pharmacy invoices from hospices
Demonstrate basic understanding of Enclara Pharmacia standard/custom formularies
Understand formulary and billing platform differences (PD vs. FFS) from hospice to hospice
Assist Customer Service team with claims research/resolution via dispensing systems, PBM systems and fax systems
Evaluate compound claims for proper ingredients/qtys/cost and ensure timely claims adjudication
Research claims for hospice/pharmacy audits
New Hospice Start-Ups:
Complete assigned facility/pharmacy spreadsheet by contacting both the facilities and pharmacies to verify accuracy of all information provided
Coordinate all information for facility pharmacies including verification of PBM systems
Update facility pharmacy spreadsheets and implementation team members on the progress with these pharmacies
Communicate with the facility pharmacies on proper billing procedures and contact information for rejected claims
New Facilities:
Gather partial information from Call Center on facilities not listed and obtain correct information to be entered into the database
Link facilities to their respective hospices once all information is obtained.
Assist with Confirmation Fax reports to update facility and pharmacy relationships and demographic information
Qualifications:
Strong verbal and written communication skills, including the ability to tailor
communication to audience
Self-motivated, organized
Team player
Problem-solving skills and ability to follow through on tasks assigned
Ability to handle multiple tasks, meet deadlines, and follow-up timely
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
At least 1 year of Pharmacy Technician experience
Knowledge of pharmacy claims and adjudications
High school diploma
Preferred Experience:
PBM experience
Dispensing system experience
CPhT or EXCPT
Computer Skills:
Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Company info
Humana Inc.
Website : http://www.humana.com