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Insurance Collections Services Associate II
2 months ago
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Insurance Collections Services Associate II – Pharmacy (NCPDP)
Salary Range: $17.00-$20.00 hr
Schedule: 6:00am-3:00pm PST
Insurance Collections Services Associate II – Pharmacy is responsible for seeking reimbursement/recovering overpayments from third parties, dispensing pharmacy providers, PBM’s, healthcare facilities and/or insurance carriers on overpaid NCPDP pharmacy drug claims for CPIS clients. These claim overpayments are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc. The Insurance Collections Services Associate II – Pharmacy is responsible to meet all performance standards: collection goals, compliance, and production to ensure calls are timely, maximum call time is achieved, and ensures quality results.
Insurance Collections Services Associate II – Pharmacy will handle the recovery of pharmacy related Medicare Part D, Medicaid and commercial claim overpayments identified through various audits. Responsibilities include (but are not limited to):
- Recovery of pharmacy claim overpayments through direct outreach via phone, e-mail, or fax method with pharmacies, PBM’s, insurance carriers.
- Communicates effectively with other staff/team members.
- Coordinates collection efforts between the client and the provider, adjusting claims/reversals as required.
- Develops effective collection approaches and workflows to maximize recovery opportunities.
- Communicates with plan carrier’s PBM regarding Medicare Secondary Payer requirements, as well as drug exclusions under Medicare Part D.
Experience:
- Strong background in pharmacy billing concepts, including pharmacy billing and claim recovery (collection) experience. Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid.
- General understanding of:
- Third-party reimbursement types (i.e. PBM, medication assistance programs, self-pay)
- Healthcare reimbursement in different settings (i.e., home health, long term care, home infusion, health systems, community pharmacy, and ambulatory clinics.
- Drug related reimbursement calculations in different forms (i.e., oral/PO, injections, infusions, topicals, etc.)
- Eligibility verifications surrounding BIN/PCN combinations and payer sheets
- Coordination of Benefits (COB) to determine each party’s responsibility.
- Interpreting EOB’s, ERA’s (electronic remittance advice) for understanding of allowable rates, rejection codes and patient accumulations.
- CMS guidelines surrounding Medicare Part D, including rejections, external code lists and drug exclusions
- Familiarity with NCPDP claims, NDC’s, and reimbursement terms.
- Experience with pharmacy PA’s and overrides preferred.
- Professional verbal and written communication skills required. Excel knowledge strongly preferred.
- Minimum 1-year experience with pharmacy billing/insurance collections.
Education: Associates Degree or equivalent combination of education and experience.
Pay Transparency Statement:
Pay transparency laws in some locations require disclosure of compensation-related information. For this position, actual salaries will vary and may be above or below the range based on various factors, including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive.
Furthermore, Conduent provides a variety of benefits to employees, including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.
The estimated salary range for this role is $17-20 per hour.
