New Job Pharmacy Claims Review Specialist In Idaho

Pharmacy Claims Review Specialist

Overview of Position
The Pharmacy Claims Auditor will be responsible for conducting reviews of pharmacy providers and related programs reimbursed by state, federal, or private entities. Responsibilities include collecting and evaluating pharmacy claims, records, and any other health related records for the purpose of identifying areas of fraud, waste, or abuse in the pharmacy program.

What will be my duties and responsibilities in this job?

• Conducts pharmacy concurrent bill claim reviews ensuring Claims adhere to State, Federal and Contractual requirements. Analyze results, contact pharmacies for claim correction and recoupment and document and track results
• Conducts pharmacy Desk Audits of defined Claims to adhere to State, Federal and contractual requirements, analyze results, contact pharmacies for claim correction and recoupment and document and track results
• Prepares and submits monthly reports for client, summarizing activities, findings and recoveries.
• Attend client Meetings as needed
• Coordinate, document and track On-Site audits. Provide data to client and facilitate vendor findings.
• Communication: Educate Pharmacy staff on claim reviews and provide guidance on appropriate future submissions. Coordinate with compliance team for further contractual activities as a result of audit findings and responses.
• Gather, analyze audit results to review algorithm for trends and recommendations

What are the requirements needed for this position?

• CPhT required
• H.S. Diploma or GED required.
• 5+ years pharmacy experience, either working in a pharmacy or within a healthcare pharmacy claims review setting

What other skills/experience would be helpful to have?

• Bachelor’s degree preferred, experience will be considered in leu of degree
• Experience in pharmacy claims review
• Excellent time management skills
• Experience within PBM industry
• Healthcare Knowledge
• Pharmacy audit experience
• Effective communicator – verbal and written
• Highly Analytical and detail oriented
• In depth knowledge of Excel
• SQL or database experience a plus
• Strong Communication Skills
• Think innovatively
• Strong attention to detail
• Ability to analyze policies and procedures, reach logical conclusions, and make sound recommendation for audit finding

What are the working conditions and physical requirements of this job?

• General office demands
• Office environment for remote worker and efficient, high-speed internet

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to [email protected] with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.