MANAGED CARE REIMBURSEMENT SPECIALIST - CORPORATE PHARMACY #140-06A (140-06A)

Description


The Corporate Pharmacy Department, located at The National Services Center in Phoenix, AZ, has an opening for a Managed Care Reimbursement Specialist.

Key Responsibilities include, but are not limited to:


Develop, Implement & Manage processes for reimbursement enhancement, audit prevention edits, MAC Analysis and overall Third Party performance, and other items as needed.
Develop, Implement and manage ad hoc and existing and new Per-Se PPE and reports for Pre and Post Editing that detail edit activity and value added and communication of results to stakholders.
Analyze and make recommendations for internal control processes that enhance filling practices through the use of Pre and Post Editing.
PDX Claims analysis / support through the use of edits to make improvements to internal software.
Train, develop and assist in the growth of employees in accordance with Safeway policies and procedures.
Work closely with Corporate and division pharmacy operations to build and grow pharmacy business, as well as identify, develop and manage processes to maximize profitability and sales.
Act as the primary liaison in regards to Edit development for Compliance, Pharmacy Care, Operations, Managed Care, Accounting, and Software functional departments.
Interface closely with Corporate and Division Pharmacy Directors, Corporate Legal, Regional Pharmacy Managers, Managed Care National Accounts, Stores, A/R and Rx Support, to identify & help resolve potential leakages in profitability and reimbursement, as well as assist in training with respect to managed care initiatives.
Participate with Per-Se training calls and disseminate information to shareholders.

 Required Skills


Qualifications: The following are preferred or desired unless specifically stated:


3-5 years experience / background with pharmacy operations.
2 year AA Degree. Pharmacy Technician certification/background or experience; advanced degrees preferred.
In-depth knowledge of pharmacy operations, and federal and state legislation affecting pharmacy trends.
Familiarity with National Managed Care Organizations.
Strong familiarity with Pharmacy claims, PDX and issues around the claims adjudication process.
Strong financial analytical skills required.
Strong analytical/math skills with data management required.
Strong PC skills including Microsoft Office (Excel, Word, Access).
Excellent oral and written communication skills.
Strong problem solving abilities, attention to detail and multi tasking.
Self-starter, able to work with minimum supervision.