We are seeking motivated, collaborative people to fill this full-time Pharmacy Technician opportunity. This positon will operate in a corporate environment on an established work schedule of Monday through Friday, generally 8:30am to 5:00pm. As a full-time employee you will be eligible to participate in our generous benefit package which includes Health, Dental and Life insurance, tuition reimbursement, paid-time off, etc. The office is closed for (7) observed paid holidays.
The primary purpose of the (Pharmacy Tech) - High Cost Drug (HCD) Claims Selection Analyst is to review client claims data and identify claims suitable for HCD audits. This position will also perform some clerical duties to support the HCD Pharmacist auditor. The HCD Claims Selection Analyst must be professional, motivated, a self-starter and able to work independently and must detail orientated. Must actively participate with other staff as part of an effective work team.
- Reviews HCD claims data to identify possible HCD billing, dosing and medical necessity discrepancies.
- Incorporates feedback from HCD Pharmacist and audit data to refine selections process.
- Consults client claims system to determine prior authorization and reimbursement overrides.
- Interacts with internal Carewise Health leadership and Payment Integrity staff on a regular basis.
- Informs senior management of work activities and identifies procedural issues and concerns that may affect the work of the unit.
- Receives and acts on requests from team members, HCD auditors and communicates results to appropriate parties.
- Maintains workflow and timelines for all client deliverables.
- Assists department with special projects as needed.
- All other duties as assigned.
- High School Diploma or equivalent (GED)
- Certified Pharmacy Technician (at least three of years experience) -Proficient in Microsoft Excel and Microsoft Word.
- Attention to detail is a must. -At least one year of Medical Claims or Pharmacy administrative experience is preferred. -HCPCS coding knowledge preferred, with emphasis on injectibles and other high cost drugs (J Codes).
- Ability to prioritize multiple tasks.
- Works in a well lighted/ventilated office area with some changes of temperature, as well as throughout the premises. Associate will spend majority of the time indoors.
- Prolonged sitting at a computer with some standing and bending intermittently during work hours.
- Is subject to frequent interruptions.
- Ability to move arms, hands, and fingers to type.
- Close vision required for computer monitors.
Job Location Louisville, Kentucky, United States Position Type Full-Time/Regular
About this company
The key to improving the outcomes for health plan participants involves greater abilities to predict the future of an individual’s health care needs, and how they will behave in response to their interaction with the health care system.
Certilytics, Inc. gathers, assembles and enriches disparate data to give unique insight to risk management, profiling, population health and management, and financial analysis.
Location/Region: Louisville, KY