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Five years’ experience in the healthcare industry working for a health plan, hospital system, pharmacy benefit manager (PBM), or third-party administrator (TPA) is preferred. Combined fifteen years’ experience owning the strategy, planning and implementation work for brand positioning, brand marketing, demand generation marketing, media management, digital marketing, social media marketing, marketing analytics, market research, community relations, corporate communications, employee communications, content marketing, and web content management.
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Experience with modeling software and techniques such as DEM, FEA, PBM, AI/ML (ANN, random forest, etc.) Familiarity with a variety of analytical/material characterization techniques, spectroscopy, chemometrics and/or PAT tools.
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Provider, administrative, contract, negotiation, recruiter, recruitment, provider relations, Healthcare, call center, mail order medications, Insurance Verification, Medicare, Medicaid, Medical billing, EOB, Benefit, Patient Service, PBM, Enrollment, Provider Services, Pharmacy, prior authorization, reimbursement counselor, Medical customer service, inbound calls, outbound calls, answer phones, make calls, medical terminology, medical office, medical claims, healthcare claims, claims processing.
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You will oversee both internal and third-party audits, ranging in scope from prescription audits, processes audits, inventory audits, and claims audits, 340B and workflow compliance, credentialing with PBMs and PBM provider manual expertise.
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PBM/Health Plan experience evaluating and reviewing Prior Authorization preferred Specialty Pharmacy experience preferred MTM certification or other specialty certifications preferred Why Join Us: EmpiRx Health is on an extraordinary journey where excellence meets innovation.
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Exposure to healthcare data (payor claims processing, EDI, EHR, HIE, PBM) Proficiency with SQL for multiple databases (BigQuery, standard MSSQL, PL/SQL, MySQL, PostgreSQL, Teradata) Exposure to healthcare data (payor claims processing, EDI, EHR, HIE, PBM.
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The Risk Analyst and Underwriter Advisor will be required to gain in-depth knowledge of the PBM Industry and Express Scripts Inc. specific underwriting methods. Experience in Pharmacy Benefits Manager (PBM), Managed Care, Healthcare, Pharmaceutical preferred.
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Medicare Part D and PBM experience is highly desired. A minimum of a bachelor’s degree in Finance or Accounting is requiredA minimum of five years in a corporate Financial Analyst role with a Medicare health plan or PBM is required.
$61,968 - $80,633 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience in the healthcare industry, including 340B, pharmacy, hospital, clinic, PBM. Operating nearly 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day.
$60,600 - $97,200 a yearFull-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Generate insights and develop KPIs as part of US market access readiness launch activities, including evaluating in-market analogs pricing & contracting environment, payer/PBM landscape, clinic/hospital economics, employer groups, value-based agreements and other landscape activities.
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Review Prescriptions: Review prescriptions requiring prior authorization according to PBM guidelines. As a Prior Authorization Specialist, your primary responsibility is to assist in the prior authorization process for prescription medications.
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Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services. Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues.
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You will be responsible for drafting, negotiating, reviewing and advising on various agreements, including consulting agreements, master service agreements, supply agreements, distribution agreements, advisory agreements, market access-related agreements (including: PBM, Payer, and GPO agreements), wholesaler agreements, discount and rebate agreements.
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Loads the appropriate insurance plan to the patients profile for adjudication, runs test claims and makes the necessary outreach to the Health Plan (HP) and/or Pharmacy Benefit Manager (PBM) to resolve rejected claims and/or contact patients and/or prescribers to collect additional information or data needed for a successful claim submission (i.e. patient demographics, new insurance information.
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Your responsibilities include oversight of the daily pharmacy program operations, oversight of the contracted Pharmacy Benefits Manager (PBM), oversight of the specialty pharmacy vendor, oversight of any groups delegated to provide a pharmacy service and providing clinical integration of the pharmacy program with our internal disease and case management programs.
$221,000 - $243,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday
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