- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …utilization management information in all relevant systems including but not limited to PBM claims processing system, annual printed formularies, BCBSLA ... Medicare Part D team, and clinical areas of Medical Management, PBM clinical personnel, and e-hosting formulary vendor personnel. **QUALIFICATIONS** **Education** +… more
- Medical Mutual of Ohio (OH)
- …of CMS guidelines and Medicare Part D (pharmacy). . Knowledge of pharmacy claims processing through retail or mail pharmacy. . Intermediate Microsoft Office ... resolution either directly or forwards/escalates to other departments or PBM . Monitors paid claims for accuracy including...Medicare Part D (pharmacy). . Strong knowledge of pharmacy claims processing through retail or mail pharmacy.… more
- Health First (Rockledge, FL)
- …or healthcare setting * Knowledge/Skills/Abilities: o Knowledge of pharmacy workflow from processing claims to authorizing PA requests, formulary management, and ... daily pharmacy program operations and the contracted Pharmacy Benefits Manager ( PBM ). Ensure achievement of organizational and departmental goals through vigorous… more
- Conduent (Elkridge, MD)
- …We offer solutions for Medicaid payments, healthcare, pharmacy benefits management and claims processing . **About the role** Take ownership for developing and ... Sign on Bonus!!** **Does your Account Management experience include PBM Fee For Service (FFS) services?** **Are you presently...advocate for successful change + Remain current on pharmacy claims processing industry trends, best practices s… more
- The Cigna Group (St. Louis, MO)
- …The Lead Analyst will support analytics of operational data, specific to claims processing , adjustments, and PDE/Encounters for the client. The role ... / Health Care Reform). The team supports Pharmacy Benefit Management ( PBM ) delegated responsibilities associated with regulatory audit support, issue management,… more
- Prime Therapeutics (Columbus, OH)
- …needs. + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and ... of Service Level Agreement performance, assurance of accuracy of claims payment and administrative policies, rate maximization...+ 5+ years' experience in pharmacy, managed care or PBM + 2+ years' experience in a leadership role.… more
- G-TECH Services, Inc. (Detroit, MI)
- …Excel, Word, Access) * Knowledge of prescription drug names, therapeutic classes and claims processing * Knowledge of Privacy Regulations * Pharmacy Technician ... * Minimum 2 years of experience in Pharmacy Retail, PBM , Hospital, Managed Care * Experience with Microsoft Programs...* Knowledge of CMS/NCQA regulations * Knowledge of pharmacy claims processing Education/Certifications - Include: * High… more
- Prime Therapeutics (Columbus, OH)
- …responsibility of the Vendor. Requirements: + Extensive knowledge of Medicaid and NMAP claims processing and pharmacy benefits management. + At least three (3) ... essential for both the client's cost of care and the overall administration of the programs. Activities address impact on customers, operations, program integrity,… more
- UPMC (Cumberland, MD)
- …admixtures and TPN (Total Parenteral Nutrition)) for the correct patient for administration at the appropriate time. Use proper technique in the preparation of ... laws such as HIPAA, regulations such as OSHA, and PBM contracting requirements such as FWA and CMS. +...as refill coordination and medication synchronization. + PRIOR AUTHORIZATION PROCESSING : possess a high level of knowledge regarding insurance… more
- UPMC (Pittsburgh, PA)
- …with Federal and State laws such as HIPAA, regulations such as OSHA, and PBM contracting requirements such as FWA and CMS. + Distribution: Develop and maintain ... admixtures and TPN (Total Parenteral Nutrition)) for the correct patient for administration at the appropriate time. Use proper technique in the preparation of… more
- UPMC (Pittsburgh, PA)
- …with Federal and State laws such as HIPAA, regulations such as OSHA, and PBM contracting requirements such as FWA and CMS. + Distribution: Develop and maintain ... admixtures and TPN (Total Parenteral Nutrition)) for the correct patient for administration at the appropriate time. Use proper technique in the preparation of… more