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Pharmacy Claims Specialist

Enclara Pharmacia

This is a Contract position in Philadelphia, PA posted August 13, 2019.

Job Description: Are you compassionate?


Seeking to make a difference?

A career at Enclara Pharmacia means the opportunity to work with, fun, bright, caring, enthusiastic professionals who can turn tough challenges into real solutions.

We recruit and develop energized people who can add meaningful value to our company, and who have a desire to enrich their careers in an expanding area of healthcare while making a positive, direct impact on patients and their loved ones’ lives.

Make a difference today and join Enclara Shift: Monday through Friday, 2:30 PM to 11:00 PM, with every 4th Saturday rotations Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues.

Essential Duties and Responsibilities: Assist in setting up and maintaining hospice/facility/pharmacy relationships under the direction of the Pharmacy Claims (Support Services) Manager and the Director of Support Services Assist pharmacies with claims adjudication Complete incoming tasks as assigned by the Pharmacy Claims (Support Services) Manager Obtain all necessary information for facilities and their related pharmacies Assist the Call Center management team with projects to enhance the workflow and success of the Call Center Assist Customer Service team with claims research/resolution RESPONSIBILITIES (include but are not limited to): Billing: Assist pharmacies with claims adjudication by adjusting/correcting authorizations in dispensing systems and PBM systems Ensure timely adjudication of prescription claims through PBM systems Contact hospices for authorizations/approvals for submitted claims where necessary Ensure accuracy of patient profile data including related/not related status, authorization status, etc Research and correct pharmacy invoices from hospices Demonstrate basic understanding of Enclara Pharmacia standard/custom formularies Understand formulary and billing platform differences (PD vs.

FFS) from hospice to hospice Assist Customer Service team with claims research/resolution via dispensing systems, PBM systems and fax systems Evaluate compound claims for proper ingredients/qtys/cost and ensure timely claims adjudication Research claims for hospice/pharmacy audits New Hospice Start-Ups: Complete assigned facility/pharmacy spreadsheet by contacting both the facilities and pharmacies to verify accuracy of all information provided Coordinate all information for facility pharmacies including verification of PBM systems Update facility pharmacy spreadsheets and implementation team members on the progress with these pharmacies Communicate with the facility pharmacies on proper billing procedures and contact information for rejected claims New Facilities: Gather partial information from Call Center on facilities not listed and obtain correct information to be entered into the database Link facilities to their respective hospices once all information is obtained.

Assist with Confirmation Fax reports to update facility and pharmacy relationships and demographic information Required Experience: Qualifications: Excellent verbal and written communication skills Self-motivated, organized Team player Ability to manage multiple priorities Problem-solving skills and ability to follow through on tasks assigned Education and/or Experience: 6 months of pharmacy technician experience Must work in-office PBM experience preferred Dispensing system experience preferred High school diploma required Computer Skills: Proficient in Microsoft Office Certificates, Licenses, Registrations: CPhT preferred Please note that Enclara Pharmacia, Inc.

and any of its affiliated companies does not seek or accept unsolicited resumes or offers of recruiting service associated with any published or unpublished employment opportunities.

Any unsolicited information sent to Enclara or any of its employees will be considered as unencumbered and free from any fee or charge whatsoever.

Any outside recruiting services, and associated fees, if any, will be authorized only pursuant to a signed written contract approved by Enclara Pharmacia’s Legal department.

ZR Keyword: Pharmacy Technician, Pharmacy Claims, Claims, Billing, Pharmacy Billing From: Enclara Pharmacia Apply now