TEK Connexion · 1 day ago
Retail Pharmacy Insurance Claims Analyst
United States
Contract
Remote
Mid Level
$20/hr - $22/hr
3+ years expTEK Connexion is seeking a Retail Pharmacy Insurance Claims Analyst. The role involves processing healthcare claims, ensuring accuracy and compliance, and investigating claims for potential fraud, waste, or abuse.
Information ServicesInformation TechnologyRecruiting
Hiring Manager
Melanie Gillot
Responsibilities
Review and validate disbursement requests to ensure accuracy, completeness, and proper documentation
Research rejected, transitioned, and paid claims to confirm validity and escalate issues as needed
Utilize departmental and enterprise systems to research claims and understand system interactions
Investigate claims to identify potential fraud, waste, or abuse, as applicable
Monitor inventory and claims reports to ensure timely and accurate resolution
Provide documentation to support audit requests
Communicate with internal and external stakeholders via written and verbal correspondence to resolve claims issues
Research claims related to billing and crediting groups to ensure accurate adjustments
Ensure proper claim adjustments are completed so groups are correctly billed or credited
Qualification
Required
Prior experience in a retail pharmacy environment is required
High school diploma or equivalent required
Minimum of 3 years of experience processing healthcare claims
At least 2 years of experience working with claims processing systems (experience may be concurrent)
Strong working knowledge of claims payment and refund policies
Familiarity with claims-related software systems
Knowledge of medical terminology and coding standards, including CPT IV, ICD-9, and/or NCPDP coding, as applicable
Strong analytical skills with the ability to retrieve, review, and research automated reports
Effective time management skills with the ability to adapt to changing priorities
Strong written and verbal communication skills
Proficiency with standard office equipment and data entry tools
Required License/Certification: Division 6B certification or State/National Pharmacy Technician Certification (CPhT)
Preferred
Bachelor's degree in Business, Computer Science, Healthcare Administration, or a related field
Four (4) years of related experience may be considered in lieu of a degree
Experience with claims processing systems such as RMMS, CES, AMMS, ITS, SOND, INFO, third-party recovery displays, and ALGS
Excellent written and verbal communication skills
Knowledge of electronic data processing systems and their integration with user workflows
Ability to generate reports using predefined data retrieval tools such as DB2 and EZTRIEVE Plus for research and analysis
Company
TEK Connexion
TEK Connexion is a provider of technology services ,workforce solutions and staffing services.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2021-02-11Acquired
Company data provided by crunchbase