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- ...Job Description Job Description Ubicación: Guaynabo, PR El Analista de Auditoría PBM es responsable de auditar, analizar y dar seguimiento a las cuentas por cobrar relacionadas con Pharmacy Benefit Managers (PBM) en una farmacia especializada. Este rol está enfocado...Suggested
- ...Job Description Job Description Location: Guaynabo, PR PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses primarily on reviewing and validating...SuggestedWork at office
- ...# Answer incoming providers' and beneficiaries' calls following Call Center scripts, in a timely manner and in accordance with the PBM call center performance metrics. # Answer incoming calls and perform outbound calls according to HIPAA and Pharmacy Laws Standards....SuggestedTemporary workLocal area
- ...distributed based on the standards established by the business line. Receives and manages the Determination case file request with the PBM. Initially evaluates, organizes, and distributes Pharmacy Commercial Appeals (PPACA) requests in accordance with the established...SuggestedLocal area
- ...Access & Reimbursement and Patient Assistance Program (PAP) teams, ensuring timely, accurate, and complete processing of cases related to PBM benefits, medical benefits, PAP, copay assistance, and other applicable access programs. • Create work schedules, operational plans...SuggestedWork at office
- ...Job Title: Data Solution Architect Location: Dallas TX Onsite Minimum 20+ years of experience/ Pharmacy Benefit Management (PBM) must Job Details below: We are seeking a highly experienced Solution Architect to lead the end-to-end technical architecture for the CarePath...Suggested
- ...3. Provides orientation to pharmacies regarding pharmacy benefits. 4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated. 5. Assists pharmacies claim processing. 6. Assist in...Suggested
- ...EXPERIENCE Five (5) or more years of experience in a combination of financial analysis, reporting and accounting closing cycle. PBM and/or Medicare experience, preferred. PROFESSIONAL COMPETENCIES Knowledge: Expert Knowledge in MS Office, mainly Excel and...SuggestedContract workWeekend workAfternoon shift
- ...Puerto Rico Board of Pharmacy Technician Certification (Preferred). PROFESSIONAL EXPERIENCE ~ One (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy or; Proven working experience as a data analyst. PROFESSIONAL COMPETENCIES...SuggestedWork experience placementWork at officeImmediate startWeekend workAfternoon shift
- ...and file any necessary information with regulatory agencies, if appropriate. # Monitor and interpret regulatory changes impacting PBM operations, including CMS guidelines, HIPAA, and Medicare Part D. # Assist in maintaining compliance with Medicare regulations, including...SuggestedWork at officeLocal areaWeekend workAfternoon shift