Skip to main content

Third Party Insurance Analyst - Thrifty White Pharmacy - Plymouth, MN

Third Party Insurance Analyst - Thrifty White Pharmacy - Plymouth, MN -




Thrifty White Pharmacy

Plymouth, MN


PRIMARY OBJECTIVE:
To companion with the Company Supervisor of Third Party Contracting, Operational Compliance and Audits to know contracted charges, examine charges to adjudicated quantities and last quantities paid, and guarantee compliance with the contract phrases. Create a program to persistently monitor governmental funds, figuring out and refunding overpayments as wanted.


MAJOR RESPONSIBILITIES:


  • Perceive the reimbursement verbiage of the PBM contract and governmental packages so it may be validated towards adjudicated claims to make sure contract compliance (e.g., MAC, AWP, U&C, DIR/Processing/Transaction Charges, and so on.).

  • Develop and keep a program to make sure adjudicated quantities match the contract phrases. This consists of creating and analyzing the under value report and performing MAC appeals.

  • When cost is acquired, make sure the cost quantity matches the adjudicated quantity.

  • Analysis over/underpayments and supply actionable reporting to the Company Supervisor of Third Party Contracting, Operational Compliance and Audits.

  • Particularly associated to authorities plans (i.e., Medicare / Medicaid), create a program to persistently monitor claims for overpayments and refund instantly.

  • Determine options to deal with and additional forestall over / underneath reimbursement / funds, together with TWRx edits, Change Healthcare edits, retailer group coaching, and so forth.

·









15 critiques







CLICK HERE TO APPLY

Comments

Popular posts from this blog

PROJECT MANAGER (INSURANCE MULTI-DISCIPLINARY) - Spherion - Madison, WI

PROJECT MANAGER (INSURANCE MULTI-DISCIPLINARY) - Spherion - Madison, WI - Spherion, in partnership with QBE Insurance coverage is in search of a Challenge Supervisor (Insurance coverage-Multi-Disciplinary). Abstract This place works instantly with enterprise leaders, software builders, material specialists and exterior associates to handle the supply and packages and tasks. The place oversees all elements of tasks together with deliverables, deadlines, assigning duties, dangers and points and general venture progress. S/he serves as the first level of contact for undertaking standing and price range reporting and facilitating robust partnerships with stakeholders. Splendid candidates will supply sound enterprise judgment, deep organizational capabilities and a collaborative working type. Main Duties Successfully lead tasks to realize outlined enterprise outcomes by making a excessive performing staff of enterprise, IT and third-celebration stakeholders to provoke, design and supply en...

Digital Media Planner - H&L Partners - San Francisco, CA

Digital Media Planner - H&L Partners - San Francisco, CA - You’re that individual. Who is aware of digital media like no one else. Who breathes it. H&L Partners is in search of a Digital Media Planner who is aware of the rising panorama and may develop the correct methods and digital media plans for our shoppers. You’re excited to offer your POV on convention/seminars and the newest tendencies. You need to make everybody else smarter. You possibly can deal with day-to-day planning and reporting on a number of accounts. Wunderkind is your center identify. The Digital Media Planner will take part within the day-to-day planning and reporting exercise on a number of accounts, in addition to work intently with the Planning Supervisor to develop goals and methods for media plans. This place will work with the media sales group, in-home analysis departments, shoppers and artistic groups to develop distinctive and strategically applicable media approaches, together with the...

Accounting Supervisor II - Tyson Foods, Inc. - Springdale, AR

Accounting Supervisor II - Tyson Foods, Inc. - Springdale, AR - SUMMARY: This place will supervise a Buy to Pay group that handles Accounts Payable associated actions. This place will lead a staff of people with work duties associated to a number of of the next areas: transactional processing, exception decision, analysis and evaluation, inner and exterior course of help, month finish shut processes; basic ledger account reconciliation, inner controls. Different duties embrace: instantly supervise workforce members within the AP division together with hiring, coaching and mentoring of staff members; develop and implement procedures inside the division to realize course of enhancements; drawback fixing; handle relationships between AP workforce members and with inner andexternal clients; create and monitor objectives/metrics for group; guarantee particular common ledger accounts are reconciled month-to-month; help with tasks and different duties as assigned. REQUIREMENTS: Schooling: ...