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Billing Specialist I - Pharmacy Insurance Specialist

Reference Number: KBRIBS78

Billing Specialist I - Pharmacy Insurance Specialist
experience  Not Disclosed
location  Woonsocket, RI
duration  12.0 Months
salary  Not Disclosed
jobtype  Not Disclosed
Industry  Healthcare
duration  $18/hour - $23/hour
Job Description

Description :

Position Summary

As a Pharmacy Insurance Specialist, you will be responsible for ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system. The Pharmacy Insurance Specialist will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements. As a part of the Network Operations team, this role allows you to analyze third party programs, and investigate and resolve systemic issues relative to prescription claims processing that interfaces with stores, providers, patients, pricing and financial impacts to the company.

Additional responsibilities of the Pharmacy Insurance Specialist include:

-Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations
-Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims processing support for all system related issues or enhancements including defining business scenarios and testing procedures, analyzing production issues for any potential causes and recreating all known defects in test environments to assist development
-Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results


Required Qualifications :

-1+ year related experience in a pharmacy, PBM, or insurance position
-1+ years of experience using Microsoft Word and Excel

Preferred Qualifications :

- Pharmacy Technician Experience within the past 5 years
- Previous experience with business-to-business, interdepartmental, or customer interactions
- Retail Pharmacy help desk experience
- Experience with SQL or Access

Education :

- Verifiable High School Diploma or GED

Safety Sensitive Role

Note ;

M-F 8:30-5
Onsite - 3 days a week Tuesday-Thursday
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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