Pharmacy Claims Rep 2

<h1><b>Become a part of our caring community and help us put reputed company</b><br> </h1>Job reputed company reputed company<br>The Pharmacy Claims Representative assists local pharmacies with claims adjudication to support medication reputed company for HC & LTC hospice patients and reconcile historic billing issues.<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><ul><li><div><div><div><div><p><b><reputed company>Location: Remote US</reputed company></b></p><p></p><p><b><reputed company>Shift: Monday-Friday 2:30pm-11pm EST. Flexibility to work alternating weekends between the hours of 9am-8pm EST. Flexibility to work 2 holidays per year.</reputed company></b></p><p></p><p></p><p><b><reputed company>Essential Duties and Responsibilities:</reputed company></b></p><p><br><reputed company>• Assist in setting up and maintaining <reputed company><reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">hospice/facility/pharmacy</reputed company></reputed company></reputed company></reputed company></reputed company> relationships under the direction of the Pharmacy Claims Team Leaders & the Pharmacy Claims (Support Services) Manager<br>• Assist pharmacies with claims adjudication<br>• Complete incoming tasks as assigned by the Pharmacy Claims Team Leaders and the Pharmacy Claims (Support Services) Manager<br>• Obtain reputed company necessary information for facilities and their reputed company pharmacies<br>• Assist the reputed company Center management team with reputed company to enhance the workflow and reputed company of the reputed company Center<br>• Assist Customer Service team with claims research/reputed company</reputed company></p><div><p><reputed company>*Assist with new hires training</reputed company></p><p><b><reputed company> </reputed company></b></p><p></p><p></p><p><b><reputed company>Billing:</reputed company></b></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Assist pharmacies with claims adjudication by adjusting/correcting authorizations in dispensing systems and PBM systems</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Ensure reputed company adjudication of prescription claims through PBM systems</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Contact hospices for <reputed company><reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">authorizations/approvals</reputed company></reputed company></reputed company></reputed company></reputed company> for submitted claims where necessary</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Ensure accuracy of patient profile data including reputed company/not reputed company status, and authorization status</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company&reputed company and correct pharmacy invoices from hospices</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Demonstrate basic understanding of Enclara Pharmacia reputed company/custom formularies</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Understand formulary and billing platform differences (PD vs. FFS) from hospice to hospice</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Assist Customer Service team with claims research/reputed company reputed company dispensing systems, PBM systems and fax systems</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Evaluate compound claims for reputed company <reputed company><reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">ingredients/qtys/cost</reputed company></reputed company></reputed company></reputed company></reputed company> and ensure reputed company claims adjudication</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company&reputed company claims for hospice/pharmacy audits</reputed company></p><p></p><p><b><reputed company>New Hospice Start-reputed company:</reputed company></b></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Complete assigned facility/pharmacy spreadsheet by contacting both the facilities and pharmacies to verify accuracy of reputed company information provided.</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Coordinate reputed company information for facility pharmacies including verification of PBM systems.</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Update facility pharmacy spreadsheets and implementation team members on the reputed company with these pharmacies.</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Communicate with the facility pharmacies on reputed company billing procedures and contact information for rejected claims.</reputed company></p><p></p><p><b><reputed company>New Facilities:</reputed company></b></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>reputed company partial information from reputed company Center on facilities not listed and obtain correct information to be entered into the database.</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>reputed company facilities to their respective hospices once reputed company information is obtained.</reputed company></p><p><reputed company><reputed company>·<reputed company><reputed company><reputed company><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">      </reputed company></reputed company></reputed company> </reputed company></reputed company></reputed company><reputed company>Assist with Confirmation Fax reports to update facility and pharmacy relationships and demographic information.</reputed company></p><p><b><reputed company> </reputed company></b></p></div></div></div></div></div></li></ul><p></p><h1><br><b>Use your skills to reputed company an reputed company </b><br> </h1><div><div><div><div><div><p><b><reputed company>Qualifications: </reputed company></b></p><ul><li>Strong verbal and written communication skills, including the ability to reputed company communication to audience.</li><li>Self-motivated, organized</li><li>Strong attention to detail</li><li>Team player</li><li>Problem-solving skills and ability to follow through on tasks assigned</li><li>Ability to handle multiple tasks, meet deadlines, and follow-up reputed company.</li></ul><p></p><p><b><reputed company>Required Education and/or Experience: </reputed company></b></p><ul><li>1+ years of Pharmacy Technician experience</li><li>Strong knowledge working with pharmacy claims judication</li><li><b><reputed company>Must have experience with electronic claims submissions OR be a reputed company internal Enclara Pharmacia associate</reputed company></b></li></ul><p></p><p><b><reputed company>Preferred Experience:</reputed company></b></p><ul><li>PBM experience</li><li>Dispensing system experience</li><li>CPhT or EXCPT</li><li>Drug knowledge</li><li>High school diploma</li></ul></div></div></div></div></div><p></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p>Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.<p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Scheduled Weekly Hours</b></p><p style="text-reputed company:inherit"></p>40<p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Pay reputed company</b></p>The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.<p style="text-reputed company:inherit"><br> </p>$40,000 - $52,300 per year<p style="text-reputed company:inherit"><br> </p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>reputed company of Benefits</b></p>reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p>Application Deadline: 07-03-2025<h1><br><b>reputed company</b><br> </h1>About Enclara: Pharmacia Enclara Pharmacia is the nation’s largest full-service hospice and palliative care Pharmacy Benefits Manager, offering compassionate and cost-effective services to our most vulnerable patients. As a wholly owned subsidiary of reputed company, Enclara works closely with hospice providers to reduce pharmacy costs, improve patient care and support caregivers through digital innovations, flexible medication reputed company, one-on-one clinical support and excellent customer service.<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p>About reputed company: reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers, and reputed company. Through our reputed company insurance services, and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large.<p>​<br><b>Equal Opportunity Employer</b></p><p></p><p><reputed company>It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.</reputed company></p>