Plan Build Professional Pharmacy Remote

Profile

Description

The Plan Build Professional 1 selects, implements, and loads the system applications that administer plan provisions. The Plan Build Professional 1 work assignments are often straightforward and of moderate complexity.

Responsibilities

Summary: The Plan Build Professional 1 is responsible for performing a variety of duties supporting the management of hospice client benefit plans. These duties require a variety of skill sets including communication, customer service, analytical, and organization skills. This position requires the individual to multi-task, be extremely conscious with an attention to detail, and interface with personnel from other departments to resolve questions and issues.

Location : Fully remote position - Candidate can be located anywhere in the USA.

Essential Duties and Responsibilities:

Manage the day to day processes of the guidantRx hospice benefits and provider networks.

Manage client benefit auditing

Execute new hospice and model conversion setups.

Perform claims analysis and troubleshooting

Responsible for ensuring all benefit plan questions and issues are resolved in a timely manner

Ensure new system enhancements are tested and functioning properly.

Ensure backend reporting for new clients is setup and working appropriately.

Work with other departments to obtain all necessary information for a client benefit build or contract change.

Facility quality assurance processes for benefit setup and changes Identify and address inefficiencies to streamline current operational procedures

Perform other various duties and tasks as assigned

Required Qualifications

Ability to work on multiple priorities concurrently along with the ability to change priorities as dictated by business needs

Excellent written and verbal communication skills

Ability to meet timelines on a regular and consistent basis with minimal management oversight

Ability to prioritize assignments and tasks to assure timely completion of essential functions

High level of organization to meet timelines

Understands the importance of building a relationship with customers in order to provide high levels of customer service

Understands the reporting process to facilitate answers to customer questions or provide the information that is requested by the customer

Understands the procedures and timeframes required to provide timely reporting as required by all guidantRx customers

Clearly understands the procedures to follow when handling customer service issues and is able to follow through to ensure resolution of the issue

Be on-call 24 by 7 to resolve any issues that may arise

Education and/or Experience:

Bachelor degree in relevant area or equivalent experience required

Minimum 1 years demonstrated work experience in a PBM setting.

Computer Skills:

Proficient in MS office products including Outlook, Word, Excel and PowerPoint

Familiar with PBM claims adjudication software such as RxClaim, Pharmscreens or RxNova.

Certificates, Licenses, Registrations:

PTCB Certification a plus.

Other Qualifications

Pharmaceutical Technician Training a plus

Additional Information

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