Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Some similar recruitments
Pharmacy Clerk Jobs
Recruited by KPH HEALTHCARE SERVICES, INC 8 months ago Address Trumansburg, NY, United States
Call Center Director Jobs
Recruited by NYC Careers 8 months ago Address , New York $58,695 - $81,000 a year
Pharmacy Technician Jobs
Recruited by Kinney Drugs 8 months ago Address Richfield Springs, NY, United States
Call Center Director, Patient Outreach
Recruited by DocGo 8 months ago Address , New York $90,000 - $120,000 a year
Pharmacy Technician - Overnight Shift
Recruited by NYU Langone 8 months ago Address , New York, 10016 $68,072 - $69,112 a year
Pharmacy Technician Jobs
Recruited by NYC Health + Hospitals 8 months ago Address , New York, 10037
Physician Call Center Representative.
Recruited by Hospital for Special Surgery 8 months ago Address , New York, 10021
Call Center Representative Jobs
Recruited by Rekrooting 9 months ago Address New York, NY, United States
Call Center Space Management Coordinator
Recruited by Flik Hospitality Group 9 months ago Address , New York, 10112, Ny $23 an hour
Call Center Representative Jobs
Recruited by EyeSouth Partners 9 months ago Address Florida, United States
Pharmacy Clerk/ Technician Jobs
Recruited by Kinney Drugs 9 months ago Address Richfield Springs, NY, United States
Call Center Operator's Jobs
Recruited by Rome Health 9 months ago Address Rome, NY, United States
Pharmacy Clerk - On Job Training
Recruited by Kinney Drugs 9 months ago Address Ogdensburg, NY, United States
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 9 months ago Address Lake Placid, NY, United States
Call Center Specialist Jobs
Recruited by Phaxis 10 months ago Address New York City Metropolitan Area, United States
Pharmacy Technician Jobs
Recruited by NewYork-Presbyterian Hospital 10 months ago Address New York, NY, United States
Pharmacy Clerk Jobs
Recruited by KPH HEALTHCARE SERVICES, INC 10 months ago Address Boonville, NY, United States
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 10 months ago Address Tupper Lake, NY, United States
Pharmacy Clerk Jobs
Recruited by KPH HEALTHCARE SERVICES, INC 10 months ago Address Syracuse, NY, United States
Client Services Advisor, Call Center (E-Commerce)
Recruited by Prada Group 11 months ago Address New York City Metropolitan Area, United States
Call Center Supervisor Jobs
Recruited by AppleOne Employment Services 11 months ago Address Florida, United States
Auditor, Call Center Quality
Recruited by Molina Healthcare 11 months ago Address , Long Beach, 90802, Ca $14.90 - $29.06 an hour
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 11 months ago Address Malone, NY, United States
Pharmacy Technician Certified; Madison Ave Op/Retail Pharmacy; Full Time; Days
Recruited by Mount Sinai 11 months ago Address , New York, 10029, Ny $32.96 an hour
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 11 months ago Address Elizabethtown, NY, United States
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 11 months ago Address Clayton, NY, United States
Hybrid Call Center Representative
Recruited by New York Psychotherapy and Counseling Center 11 months ago Address , Bronx, 10451, Ny $20 - $23 an hour
Inbound Call Center Representative
Recruited by Adorama Inc. 11 months ago Address , Brooklyn, 11215, Ny $18 - $22 an hour
Inbound Call Center Representative
Recruited by Adorama 11 months ago Address Brooklyn, NY, United States
Call Center Representative 1 (Temp/Hourly)
Recruited by Higher Education Services Corporation 11 months ago Address , Albany, 12210, Ny $18.50 an hour
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 11 months ago Address Cortland, NY, United States
Call Center Receptionist Jobs
Recruited by Community Medical and Dental Care 11 months ago Address Monsey, NY, United States
Call Center Coordinator Jobs
Recruited by Revel 1 year ago Address New York, NY, United States
Call Center Representative Jobs
Recruited by Albany Gastroenterology Consultants 1 year ago Address , Albany, 12206, Ny
Pharmacy Technician, Full Time Variable Shifts - Pharmacy
Recruited by Long Island Community Hospital 1 year ago Address , Patchogue, 11772, Ny
Call Center Representative Jobs
Recruited by Finger Lakes Dental 1 year ago Address Canandaigua, NY, United States
Call Center Trainer And Quality Administrator
Recruited by Research & Marketing Strategies, Inc. 1 year ago Address , Baldwinsville, 13027, Ny
Pharmacy Clerk Jobs
Recruited by Kinney Drugs 1 year ago Address Mexico, NY, United States

Call Center Pharmacy Claims Technician

Company

Humana

Address , Brentwood, 37027, Tn
Employment type FULL_TIME
Salary
Expires 2023-06-25
Posted at 1 year ago
Job Description

Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues.
This position is for Enclara Pharmacia, a Humana company. Enclara, is a wholly owned hospice and palliative care pharmacy business acquired by Humana in 2021. Enclara is the nation’s largest full-service pharmacy benefits manager (PBM) specifically for the hospice and palliative care sectors. Serving over 450 customers and nearly 100,000 patients nationally, Enclara works closely with hospices to reduce pharmacy costs, improve patient care and support caregivers through: digital innovations, flexible medication access, one-on-one clinical support, and excellent customer service.

Responsibilities

Shift: 2:30PM-11PM Eastern time with rotating weekends every 4th Saturday and Sunday. *12% shift differential pay starting at 6PM*

Essential Duties and Responsibilities:
  • Complete incoming tasks as assigned by the Pharmacy Claims Team Leaders and the Pharmacy Claims (Support Services) Manager
  • Assist pharmacies with claims adjudication
  • 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
  • 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
  • Assist with new hires training

Billing:
  • Research claims for hospice/pharmacy audits
  • Contact hospices for authorizations/approvals for submitted claims where necessary
  • Demonstrate basic understanding of Enclara Pharmacia standard/custom formularies
  • Research and correct pharmacy invoices from hospices
  • Understand formulary and billing platform differences (PD vs. FFS) from hospice to hospice
  • Ensure timely adjudication of prescription claims through PBM systems
  • Ensure accuracy of patient profile data including related/not related status, authorization status, etc
  • Evaluate compound claims for proper ingredients/qtys/cost and ensure timely claims adjudication
  • Assist Customer Service team with claims research/resolution via dispensing systems, PBM systems and fax systems
  • Assist pharmacies with claims adjudication by adjusting/correcting authorizations in dispensing systems and PBM systems

New Hospice Start-Ups:
  • Update facility pharmacy spreadsheets and implementation team members on the progress with these pharmacies
  • Complete assigned facility/pharmacy spreadsheet by contacting both the facilities and pharmacies to verify accuracy of all information provided
  • Communicate with the facility pharmacies on proper billing procedures and contact information for rejected claims
  • Coordinate all information for facility pharmacies including verification of PBM systems

New Facilities:

  • Link facilities to their respective hospices once all information is obtained.
  • Gather partial information from Call Center on facilities not listed and obtain correct information to be entered into the database
  • Assist with Confirmation Fax reports to update facility and pharmacy relationships and demographic information

Required Qualifications:

  • Strong verbal and written communication skills, including the ability to tailor
communication to audience
  • Team player
  • Self-motivated, organized
  • 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
  • Problem-solving skills and ability to follow through on tasks assigned

Experience working in a call center or other high volume environment

  • 2 years of Pharmacy Technician experience


Preferred Qualifications:

Pharmacy claims and adjudications experience
  • PBM experience
  • CPhT or EXCPT
  • Dispensing system experience
Computer Skills:
  • Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint

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 [email protected] with instructions to add the information into the application at Humana’s secure website.

Work-At-Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Not Specified
0