Tasks and Duties of these Pharmacy Claims Analyst I : <?xml:namespace prefix = "o" />
Based on strong previous experience in Pharmacy or Healthcare Revenue Cycle processing and analysis:
- Uses analytical skills and root cause analysis skills, troubleshooting, reporting and resolution skills for pharmacy claims to ensure they are billed and processed in 100% compliance with government standards (Medicare and Medicaid) and 3rd party insurance company standards – driving complete processing in full in order to achieve company goals.
- Will prepare and implement action plans and lead claims processing improvement initiatives
- 70-80% of time is spent working in spreadsheets throughout the day, using pivot tables, V-lookup, and formulas – reporting, and analyzing claims.
- Work includes doing trending analysis, then figuring out where can we fix it
- Must be able to process pharmacy claims, identify reimbursement issues, and clear pharmacy claims rejections.
- Troubleshooting claims to complete resolution
- Analyzing claims for failures and then resolving
- Process Gap Analysis and then troubleshooting and completing to resolution
- Flow charting processes – mapping processes
- Will write up complete very thorough gap analysis documents, identifying issues, team players affected, following process through where the errors are occurring through multiple date service lanes and finally to move it to completion – taking on all the necessary steps such as a project owner, who resolves the most convoluted and complex failed claims end to end.
- Will proactively brainstorm creative or seek best practices to correct and improve end to end claims and reimbursement processes
THE SHINING STARSS FOR THESE ROLES WILL HAVE THE FOLLOWING SKILLS AND EXPEREINCE AND EDUCATIONI
- Healthcare/ Pharmacy Claims Troubleshooter, problem solver , thinking abilities, strong accountability
- Handle complex problems, often times using data analysis to evaluate identifiable factors in the pharmacy claims process
- Being engaged and caring about doing great work each day, not seeing a rejection as the end of the road, but instead a claim to troubleshot, resolve to get claim successfully through the system
- Connecting the dots, making the connections , understanding the claims process so much that you know how each of your actions will cause what consequence throughout the very complex pharmacy claims resolution process
- Ability to completely own end to end problem resolution for claims
- Good judgment in making recommendations of methods and techniques for obtaining solutions.
- Strong intermediate Excel skills – including s Pivot Tables, V-Lookups, formulas
- Able to build strong internal and external working relationships
- Must have strong Math skills.
- A minimum of 3 years’ experience in pharmacy billing (preferred) ormedical billing, collections and accounts receivables (collections) – strongly prefer 4 plus more years’ experience to depth and breadth of knowledge needed to be successful in this role
- Very good knowledge of state, federal, and 3rd party claims processing
- Must know Medicare and Medicaid Regulations and billing and coding guidelines
- Must know PBM Claims
- Must know Major Medical claims or Specialty Pharmacy Claims
- Stable job history
- Ability to work overtime as needed, participate in team meetings, and trainings as needed
- High School Diploma or equivalent
<?xml:namespace prefix = "o" />
ESSENTIAL BEHAVIORS, SKILLS, AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION
- Commitment to DaVita’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions
- Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively
- Demonstrated ability to work well with cross-functional groups
- Demonstrated interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at all levels across the company
- Approachable and open
- Demonstrated strengths in organizational, attention-to-detail, follow-through, analytical, reasoning, critical thinking, and problem solving skills
- Demonstrated ability to work in a team, facilitate effective team interactions, and to foster a positive work environment; willingness to assist teammates in order to achieve departmental goals
Join us as we pursue our vision "To Build the Greatest Healthcare Community the World has Ever Seen."
Why wait? Explore a career with DaVita today.
Go to http://careers.davita.com to learn more or apply.
DaVita is an equal opportunity/affirmative action employer. As such, DaVita makes hiring decisions solely on the basis of qualifications and experience, and without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.