Remote Pharmacy Claims Reconciliation Specialist

Summary

Join our team at House Rx as a Pharmacy Claims Reconciliation Specialist to contribute to making specialty medications more affordable and accessible for patients. As a dual role, you will analyze large volumes of data, reconcile pharmacy claims, and travel 20-30% of the time to support implementation initiatives.

Requirements

• 1+ years of pharmacy claims reconciliation experience
• A unique ability to successfully problem solve for claims reconciliation
• Exceptional organizational skills with a knack for mining through rows of data
• A background in specialty pharmacy
• You are technology savvy with prior experience working with claims management and reconciliation tools, we use EnlivenHealth
• You are an excellent communicator and can work with technical and non-technical stakeholders across the organization

Responsibilities

• Mine, analyze, and organize high volumes of pharmacy claims data from various vendor tools such as Enliven, HMA, and Inmar
• Utilize data analytics to identify trends and patterns within claims data to support reconciliation efforts
• Perform detailed reconciliations of pharmacy claims data, ensuring accuracy and completeness
• Diagnose issues when discrepancies arise in data matching, employing complex problem-solving skills to resolve inconsistencies
• Analyze claims data to detect unusual patterns or trends that may indicate systemic issues or opportunities for process improvements
• Develop insights that inform operational strategies and enhance the accuracy of claims processing
• Prepare comprehensive reports detailing reconciliation findings, identified issues, and recommendations for corrective actions
• Maintain clear documentation of reconciliation processes and data analyses for compliance and auditing purposes
• Ensure adherence to regulatory requirements and company policies throughout the claims reconciliation process
• Participate in quality assurance initiatives to improve overall claims accuracy and efficiency
• Coordinate the implementation of new pharmacy systems and processes, ensuring alignment with operational goals
• Collaborate with cross-functional teams to develop and execute project plans
• Provide training and support to staff during system implementations, ensuring a smooth transition
• Travel to various locations (20-30%) to facilitate on-site training and support for new processes
• Serve as a liaison between internal teams and external vendors to ensure successful implementation outcomes
• Collect feedback from stakeholders to identify areas for improvement in the implementation process

Benefits

• Flexible work hours and flexible paid time off
• Work remotely
• Generous parental leave
• Comprehensive healthcare, vision and dental benefits