Pharmacy Claims Specialist Remote

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Job Information

Humana

Pharmacy Claims Specialist, Remote

in

Torrance

California

Description

Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues.

Responsibilities

Schedule:

Monday through Friday 2:30PM to 11:00PM ET, with every 4th weekend rotation (Sat & Sun - off by 8 PM ET)

Location:

Remote USA - Pharmacy Technician license is required if the BOP requires licensing for techs in your state.

Essential Duties and Responsibilities:

Assist in setting up and maintaining hospice/facility/pharmacy relationships under the direction of the Pharmacy Claims Team Leaders & the Pharmacy Claims (Support Services) Manager

Assist pharmacies with claims adjudication

Complete incoming tasks as assigned by the Pharmacy Claims Team Leaders and 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

Required Qualifications

Less than 2 years of technical experience

Less than 5 years of data analysis & problem solving skills

Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint

Strong verbal and written communication skills, including the ability to tailor communication to audience

Strong organizational and time management skills

Ability to handle multiple tasks, meet deadlines, and follow-up timely

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

High School Diploma or GED

Previous experience with pharmacy benefits management

Claims experience

Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)

Pharmacy Tech experience

Additional Information

COVID 19 Vaccination:

For this job, associates are required to be fully COVID vaccinated (preferred) or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols OR  

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com