PHARMACY REIMBURSEMENT SPECIALIST

3 weeks ago

Gouverneur NY USA, United States KPH Healthcare Services, Inc. Full time
**Overview**

**Scope of Responsibilities** : Works under minimal supervision within Accounting and Finance department to ensure timely review of data for reporting to stores, outside Third-Party Business partners, as well as government agencies. Prepares reports and maintains various files and information for the department ensuring proper reimbursement **.** Works collaboratively within the department to ensure licensing, credentialing and all necessary paperwork are in place for billing.

**Job Summary:** Assists and supports the Accounting and Finance department in the achievement of Rx sales, gross margin according to plan.

THIS IS NOT A REMOTE POSITION. OFFICE WILL BE IN SYRACUSE OR GOUVERNEUR, NY.

**Responsibilities**

**Job Duties:**

+ Responsible for reviewing, identifying and correcting billing issues based on contractual agreements.

+ Responsible for PBM related billing communications regarding better reimbursement strategies and issues faced to all locations.

+ Assist in auditing plans to verify contractual compliance.

+ Responsible for monitoring MAC pricing and submitting MAC appeals daily and developing and maintaining MAC reporting and analysis.

+ Responsible for using daily/weekly/monthly reports for Third Party billing and pricing accuracy to maintain the highest level of profitability. Working with the Pharmacy Business Analyst to develop reporting as needed to gain efficiencies and improved profitability.

+ Responsible for monitoring and sending claims via the AWP resubmission tool and analysis reporting of outcomes.

+ Responsible for reviewing, analyzing, and developing edits internally and through our switch that can improve efficiencies and/or profitability.

+ Assist Third Party Administrator/ Reimbursement Supervisor with licensing, credentialing, and Third-Party training programs.

+ Assist in the development and preparation of all claims related and profitability reporting.

+ Responsible for resolving Third Party pharmacy questions received from Store Systems Help Desk.

+ Responsible for yearly immunization configuration, reporting and analysis.

+ Assist Third Party Administrator/Reimbursement Supervisor in the review of plan set up within the pharmacy application.

+ Responsible for completing all mandatory and regulatory training programs.

+ Perform other duties as assigned.

**Qualifications**

**E** **xperience Preferred:**

+ Previous experience in store pharmacy operations, Third Party operations, and/or Administrative Assistant duties

**Educational Requirements:**

+ Minimum: High School Diploma or GED

+ Preferred: AS Degree or Higher in Business Administration, or related field

**Special Condiditions of Employment:**

+ Drug test

+ Initial and continuous exclusion and sanction/disciplinary monitoring

+ Any and all additional eligibility requirements based on the specific position

**Compensation:**

$16.50 - 23.00 an hour

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.

Connect With Us (https://kphcareers-kphhealthcareservices.icims.com/jobs/12406/pharmacy-reimbursement--specialist/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336031866)

**Job Locations** _US-NY-East Syracuse | US-NY-Gouverneur_

**Posted Date** _6 days ago_ _(3/28/2024 10:53 AM)_

**_Requisition ID_** _2024-12406_

**_\# of Openings_** _1_

**_Category_** _Accounting/Finance_

**_Location : Location_** _US-NY-East Syracuse_

  • Pharmacy Billing Specialist

    6 days ago

    Buffalo, NY, United States Elderwood - Pediatric Specialty Care - Woodmark Pharmacy - PostAcute Partners Full time

    Salary: Starting at $18.00 / hour Overview: Pharmacy Billing Specialist Starting Pay Rate : $18.00 / hour. Earn more based on Experience! Woodmark Pharmacy of NY is looking for an experienced, detail- oriented Pharmacy Billing Specialist to join our team and make a difference in the lives of our residents and their families. This position is on-site!...

  • Pharmacy Billing Specialist

    2 weeks ago

    Buffalo, NY, United States Elderwood - Pediatric Specialty Care - Woodmark Pharmacy - PostAcute Partners Full time

    Pharmacy Billing Specialist Starting Pay Rate : $18.Woodmark Pharmacy of NY is looking for an experienced, detail- oriented Pharmacy Billing Specialist to join our team and make a difference in the lives of our residents and their families. Full Benefits Package - Medical, Dental, Vision, Life Pharmacy Billing Specialist Position Overview: The Pharmacy...

  • Clinical Pharmacy Manager

    1 month ago

    Plattsburgh, NY, United States The University of Vermont Health Network Full time

    GENERAL SUMMARY: The Clinical Pharmacy Manager is responsible for the design, planning, implementation and maintenance of all Clinical Pharmacy programs. This individual displays competence in the 5 core health care competencies of interdisciplinary team work, quality improvement, evidence based practice, patient focused care and informatics. The Clinical...

  • PN REIMBURSEMENT SPECIALIST

    1 month ago

    Arlington, TX 76004, USA, United States Cook Children's Health Care System Full time

    The underpayment specialist is responsible for payment variance activities related to the incorrect processing of claims. Responsibilities include: validating underpayment variances and taking appropriate resolution steps, tracking underpayment recoveries, trending underpayments by payer and issue and successfully recovering underpaid amounts as efficiently...

  • Clinical Pharmacy Manager

    1 month ago

    Plattsburgh, NY, United States The University of Vermont Health Network Full time

    GENERAL SUMMARY: The Clinical Pharmacy Manager is responsible for the design, planning, implementation and maintenance of all Clinical Pharmacy programs. This individual displays competence in the 5 core health care competencies of interdisciplinary team work, quality improvement, evidence based practice, patient focused care and informatics. The Clinical...

  • Clinical Pharmacy Manager

    1 month ago

    Plattsburgh, NY, United States The University of Vermont Health Network Full time

    GENERAL SUMMARY: The Clinical Pharmacy Manager is responsible for the design, planning, implementation and maintenance of all Clinical Pharmacy programs. This individual displays competence in the 5 core health care competencies of interdisciplinary team work, quality improvement, evidence based practice, patient focused care and informatics. The Clinical...

  • Pharmacy technician

    2 weeks ago

    Albany, NY, United States PharMerica Full time

    PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Shift: Monday-Friday; 4 day shifts (10am-6pm) with 1 close shift (2pm to 10pm), 1 weekend rotation a month Flexible schedules Shift differential Health, dental,...

  • ALLIED - PEDIATRIC PHARMACY CLINICAL - PERM

    2 weeks ago

    San Antonio, TX 78229, USA, United States Protouch Staffing Full time

    Pediatric Pharmacy Clinical Manager - San Antonio, TX Full TimeShift: Days (NO WEEKENDS) Job Summary: As a Pharmacy Clinical Manager, you will be responsible for designing, implementing and managing the pharmacy clinical programs. This includes formulary management, policy and procedure development and education across the healthcare spectrum. The Clinical...

  • SENIOR CERTIFIED PHARMACY TECHNICIAN

    2 weeks ago

    US-69, Liberty, MO, USA WALGREENS Full time

    Job SummaryIn accordance with state and federal regulations assists in the training of team members under direct supervision in the practice of pharmacy within the Micro fulfillment Center. Assists leadership in the team members performance of Micro fulfillment Center duties in accordance with Company policies and procedures. Responsible for operating...

  • SPECIALIST, PHYSICAL SECURITY, H&W FIELD

    4 weeks ago

    Spring, TX 77391, USA, United States Walmart Full time

    What you'll do... We are hiring a Specialist, Physical Security working Overnight on weekends for our Walmart Central Fill Pharmacy. Walmart Central Fill Pharmacy is a specialized type of pharmacy that focuses on processing and dispensing of prescrip Field, Security, Specialist, Security Specialist, Physical, Overnight, Business Services

  • Pharmacist Resident

    2 weeks ago

    Bronx, NY, United States Etesal Health Full time

    Etesal Health is a technology platform used by healthcare professionals to find work in the area. We want to connect local leading healthcare practices with the best local talent using the Etesal Health platform. Etesal Health’s vision is to be the platform where healthcare worker shortages come to an end. We are professional, agile and innovative. In...

  • Pharmacist (Per-Diem)

    2 weeks ago

    Bronx, NY, United States Etesal Health Full time

    About us at Etesal Health is a technology platform used by healthcare professionals to find work in the area. We want to connect local leading healthcare practices with the best local talent using the Etesal Health platform. Etesal Health’s vision is to be the platform where healthcare worker shortages come to an end. We invite your great talent to join...

  • Field Reimbursement Manager

    2 weeks ago

    New York, NY, United States IQVIA Full time

    IQVIA in partnership with our client, Intercept, are excited to announce we are seeking Field Reimbursement Managers as Intercept continues to build its position as the leader in progressive non-viral liver disease, The Field Reimbursement Managers (FRM) who will be responsible for partnering with internal and external stakeholders to create and execute a...

  • TRIAGE SPECIALIST

    2 weeks ago

    Wichita, KS 67232, USA, United States Grene Vision Group Full time

    Office: Grene Vision GroupPosition: Triage Specialist Manage calls and questions from patients in a timely and orderly fashion. Prioritize calls from patients and staff based on severity of request and need.Demonstrates quality patient service during interactions with patients, coworkers, and vendors:Exhibits a positive attitude and is flexible in accepting...

  • CLINICAL ASSISTANT

    2 weeks ago

    Plano, TX 75075, USA, United States Medix Full time

    Position Summary:The Clinical Assistant assists with patient care including staffing with home care agency, facilitating communication between the intake nurses and pharmacy with home care agency, referral sources, and physician offices, and coordinatingdocumentation to ensure reimbursement for nursing visits is obtained. Clinical assistant also assists with...

  • REGISTERED NURSE

    2 weeks ago

    Brooklyn, NY 11210, USA, United States Acacia Full time

    Details: POSITION OVERVIEW: Provide medical care and services for clients with history of chemical dependence, including health history, physical examination, minor office procedures, treatment, referral, counseling and follow up care and services. Pays:$49.45 per hour KEY ESSENTIAL FUNCTIONS: Under the supervision of the Director of Nursing, act as the...

  • SKILLED NURSING BILLER

    2 weeks ago

    Allentown, PA 18103, USA, United States Phoebe Ministries Full time

    Skilled Nursing Biller - AR Specialist Full-time - Allentown, PA Phoebe Ministries is hiring a Skilled Nursing Biller - AR Specialist to join our long-term care facility in Allentown, PA. We show our employees our appreciation for their contribution towards carrying out our mission of enriching the lives of seniors. Phoebe Allentown has a beautiful,...

  • CLINICAL TRIAGE SPECIALIST

    2 weeks ago

    Long Island City, NY 11101, USA, United States LiveOnNY Full time

    At LiveOnNY we save lives, provide comfort, and strengthen legacies through organ, eye and tissue donation for the 13 million New Yorkers we serve. The Clinical Triage Specialist is responsible for evaluating, reviewing and following all vented referrals, inclusive of phone and electronic referrals. The Specialist is repsonsible for providing customer...

  • CLINICAL NURSE SPECIALIST

    2 weeks ago

    Reading, PA 19610, USA, United States Marie Lawrence Associates Full time

    Company Overview:Our client is a leading healthcare institution committed to delivering exceptional patient care and advancing nursing practice. This organization places a strong emphasis on patient outcomes, continuous quality improvement, research, and the professional development of their healthcare team.Position Overview:They are seeking a dedicated...

  • QUALITY IMPROVEMENT SPECIALIST, CLINICAL

    5 days ago

    New York, NY 10012, USA, United States VNS Health Full time

    OverviewLeads interdepartmental quality improvement activities such as development and engagement, clinical review, clinical risk management, and patient satisfaction. Serves as a resource to quality improvement committees and work groups. Analyzes outcome reports. Implements, directs and evaluates a system for quality improvement program designed to...