by twochickswithasidehustle | Oct 9, 2023 | Uncategorized
JOB SUMMARY
The Claims Auditor is responsible for maintaining the execution of pharmacy claims auditing to detect and resolve client fraud, waste, and abuse (FWA) accurately. This position has no direct reports. The incumbent is also required to perform all tasks in observance of Rite Aid’s brand and strategy and adhere to our core values and service attributes.
JOB RESPONSIBILITIES
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Perform analysis of prescriptions and other pharmacy related documentation to verify accuracy and validity of billed claims. Accurately document findings.
Research and analyze data related to pharmacy claims independently
Adhere to quality and productivity standards per department procedures
Maintain dashboard assignments in timely manner according to inventory
Identify and refer pharmacies with billing and/or documentation concerns to Special Investigations Unit for additional corrective action
Compile documentation in relation to pharmacy claims audits as it relates to departmental activities
Maintain accurate documentation of pharmacy audit (or project) progress in order to provide accurate and timely feedback to supervisory personnel
Accurate maintenance and organization of contact database and audit documentation
Communicate with doctors, pharmacies and patients, according to audit needs
Assist with research and assembly of reporting documents for clients, CMS, and internal use
Participate in Continuing Education training and webinars to enhance working knowledge of health care FWA
Develop and report department audit results
Other duties as assigned
REQUIREMENTS:
High school diploma or GED
Certified, Licensed, or Registered Pharmacy Technician
Pharmacy technician experience
Proficient in Microsoft Office and industry related software programs
Strong attention to detail and accuracy
Effective verbal and written communication skills
Ability to exercise considerable judgement, maintain confidentiality, and act in diplomatic manner
An excellent facilitator who is experienced in resolving conflicts between different parties to a dispute
A decisive individual who possesses a detail oriented perspective
Sound technical skills, analytical ability, good judgment, and strong operational focus
Ability to work with peers in a team effort
Demonstrated ability to manage multiple priorities and deadlines
A well-organized and self-directed individual who is able to work with minimal amount of supervision
Capability to efficiently complete tasks in a fast paced environment
Ability to work extended hours, weekends, and holidays pursuant with industry demands
PREFERRED QUALIFICATIONS:
Bachelor’s degree in health administration, health sciences or related field
Demonstrated pharmacy claims auditing experience
Medicare Part D knowledge
Pharmacy claims analysis experience
Bilingual in English and Spanish
PBM experience
WORK ENVIRONMENT:
Includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.
PHYSICAL REQUIREMENTS:
Ability to sit for prolonged periods of time.
EDUCATION REQUIREMENTS
Education Level
H.S. Diploma or General Education Degree (GED)
Bachelor Degree
Area of Specialization (Marketing, Finance, Pharmacy, Engineering/IT, etc)
health administration, health sciences or related field
LICENSES/CERTIFICATIONS
Licenses/Certifications
Other/List/Reason
Pharmacy Technician
KNOWLEDGE, SKILLS AND ABILITIES
Knowledge, Skills and Abilities
· Proficient in Microsoft Office and industry related software programs
Strong attention to detail and accuracy
· Effective verbal and written communication skills
· Ability to exercise considerable judgement, maintain confidentiality, and act in diplomatic manner
· An excellent facilitator who is experienced in resolving conflicts between different parties to a dispute
· A decisive individual who possesses a detail oriented perspective
· Sound technical skills, analytical ability, good judgment, and strong operational focus
· Ability to work with peers in a team effort
· Demonstrated ability to manage multiple priorities and deadlines
· A well-organized and self-directed individual who is able to work with minimal
amount of supervision
· Capability to efficiently complete tasks in a fast paced environment
· Ability to work extended hours, weekends, and holidays pursuant with industry demands
Medicare Part D knowledge
Bilingual in English and Spanish
WORK EXPERIENCE
Experience
Areas of Experience (Pharmacy, Compliance, E-commerce, Retail, etc)
Pharmacy Technician
Pharmacy Claims Auditing
Pharmacy Claims Analysis
PBM
QUALIFICATIONS
The typical starting pay range for this position is between $20.00-$27.50 an hour although wages can vary based on experience and geography.
by twochickswithasidehustle | Oct 9, 2023 | Uncategorized
Description
Full-time Remote Position
About Us:
Absolute Dental Group is a leading dental healthcare provider committed to delivering high-quality patient care throughout Nevada. We are seeking a detail-oriented and experienced Accounts Payable Clerk to join our finance team. If you are passionate about accuracy, possess excellent organizational skills, and are proficient with MS Office tools including Excel, we encourage you to apply.
Position Overview:
As an Accounts Payable Clerk at Absolute Dental Group, you will play a critical role in ensuring the smooth operation of our financial processes. You will be responsible for processing vendor invoices, managing various purchasing functions, and providing purchasing oversight to optimize cost-efficiency while maintaining compliance with healthcare industry standards. Proficiency in NetSuite will be advantageous in this role, but not mandatory. This role reports to the Accounts Payable Manager.
Key Responsibilities:
- Invoice Processing:
· Receive, review, code, and process vendor invoices for accuracy and compliance.
· Resolve discrepancies and issues related to invoices, purchase orders, and deliveries.
· Ensure all invoices are approved for payment in accordance with company policies.
- Vendor Communication:
· Maintain professional relationships with vendors, addressing inquiries and resolving payment-related issues.
- Purchasing Oversight:
· Assist in monitoring and optimizing purchasing processes to minimize costs and improve efficiency.
· Assist in the creation and management of purchase orders.
· Ensure compliance with purchasing policies and procedures.
- Data Entry and Record Keeping:
· Accurately input financial data into the company’s accounting system (NetSuite).
· Maintain organized and up-to-date records of all accounts payable transactions.
- Month-End and Year-End Procedures:
· Assist in month-end and year-end closing processes, including reconciliations and accruals.
Qualifications:
· High school diploma or equivalent; Associate’s degree in accounting or related field preferred.
· 2+ years of experience in accounts payable.
· Proficiency in MS Office suite of applications, particularly MS Excel
· Proficiency in NetSuite or similar accounting software.
· Strong attention to detail and accuracy in data entry and record keeping.
· Excellent communication and interpersonal skills.
· Ability to work independently and as part of a team.
· Familiarity with healthcare industry regulations and compliance is a plus.
· Strong organizational and time-management skills.
· Problem-solving and critical-thinking abilities.
Benefits:
· Competitive salary commensurate with experience.
· Comprehensive healthcare benefits package.
· Retirement savings plan.
· Paid time off and holidays.
· Professional development opportunities.
· A collaborative and supportive work environment.
by twochickswithasidehustle | Oct 9, 2023 | Uncategorized
locations
Work From Home – Florida
time type
Part time
posted on
Posted 30+ Days Ago
job requisition id
JR-59731
Job Summary:
Job Summary:
JOB DESCRIPTION – EVENT PROGRAMMER
Location: Remote
Division: Ticketmaster US
Line Manager: Event Programming Operations Manager
Contract Terms: Part-time, 20 hours per week (including weekends and evenings)
THE TEAM
The Field Operations team builds and maintains relationships with various clients to understand the essentials of their business practice, ensure their business objectives are met and clients are able to utilize the various Ticketmaster products/platforms.
THE JOB
As part of the Event Management team, you will support Ticketmaster clients in all their event management needs. This includes building events and making updates to events based on work requests from clients.
WHAT YOU WILL BE DOING
This position involves collecting, reviewing, and inputting accurate data into Ticketmaster Host system following procedural best practices and established standards, then verifying the output. The tool knowledge set for the position includes Host and Host applications, EventPro, EMT and TM1 suite products.
Meet and exceed Event Management service level agreements
Accurately input event data into Ticketmaster Host system and identify and resolve event related errors
Work with clients, promoters, and internal departments such as marketing, accounting, customer service, event operations and support and client support, when creating events and distributing information regarding those events
Establish and develop relationships with assigned clients
On-Call schedule rotation amongst the team; after hour, weekend and holiday client support responsibilities
From time to time, will be responsible for other duties as assigned by, but not limited to, Senior Event Specialist, the EM Manager, or the Regional Director of Event Management
WHAT YOU NEED TO KNOW (or TECHNICAL SKILLS/COMPETENCIES)
1-3 years experience with the Ticketmaster System, or related field experience, with some exposure and knowledge of the Ticketmaster system
Service oriented, with strong organizational and communication skills
Able to successfully handle multiple priorities
Certain degree of creativity, latitude, and problem solving is required
Box Office experience a plus
Overall awareness of the entertainment business is important
Knowledge of how TM departments impact on one another, and on outside clients is a plus
Must have the ability to accommodate a flexible schedule including some Saturdays, evenings, and holidays
Excellent written and oral communication skills, good organizational skills, and attention to detail
Must be computer literate with excellent data entry skills
H. S. diploma or equivalent required. BA/BS degree is preferred
YOU (BEHAVIOURAL SKILLS/COMPETENCIES)
Rock Solid Reliability – I earn the trust of clients, co-workers and fans; I set clear expectations; I deliver high quality work on time and on task; I take the time to do things right
Solution Driven – I creatively find solutions to problems clients are experiencing by collaborating with management and interdepartmentally with experts that can find alternative and effective solutions to any limitations.
Winning Teamwork – I collaborate with others; I share information openly; I listen and take time to empathise and understand where others are coming from; I show recognition and appreciation for the contributions of others
Act with Integrity – I am proud of the way I represent myself and the company to others; I act with good intentions; I have direct, honest conversations while creating a safe work environment for open dialogue; I represent information and data accurately and completely
EQUAL OPPORTUNITIES
We are passionate and committed to our people and go beyond the rhetoric of diversity and inclusion. You will be working in an inclusive environment and be encouraged to bring your whole self to work. We will do all that we can to help you successfully balance your work and homelife. As a growing business we will encourage you to develop your professional and personal aspirations, enjoy new experiences, and learn from the talented people you will be working with. It’s talent that matters to us and we encourage applications from people irrespective of their gender, race, sexual orientation, religion, age, disability status or caring responsibilities.
CULTURE
We’re fans who help fans everywhere get into the live events they love. A proud division of Live Nation Entertainment, Ticketmaster has changed the way the world connects with their favourite artists, teams, and shows, and we continue to shape innovation every day. We’re not just selling tickets (though we do that better than anyone else), we’re enriching lives one amazing experience at a time. And we think that’s pretty amazing. If you’re passionate about the magic of live entertainment like we are, and you want to work at a company dedicated to helping millions of fans experience it, we want to hear from you.
We have a ‘Fan First’ mindset, placing customers at the heart of everything we do. Whether working behind the scenes or engaging directly with the ‘Fan’ you will be part of a culture that supports and enriches the fan experience. Your work, our passion… delivering world class experiences – Fan First.
by twochickswithasidehustle | Oct 9, 2023 | Uncategorized
Description
Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations while maximizing the capture of allowable reimbursement for each client. The commitment to adherence to both principles make QMC the partner of choice for emergency medical transportation providers.
QMC is headquartered in Pittsburgh, PA. This position is remote.
Summary:
The PreBill Specialist I works under the direct supervision of the Billing Manager in cooperation with other staff providing pre-billing and coding services. Responsible for accurately and efficiently verifying prebill information, verifying patient demographics, payor information, and transport modifiers before coding. Responsible for ensuring that all of the prebill information is accurately verified and entered in the claim before the coding process. This role is critical in maintaining overall quality goals for transport billing.
To succeed in this role, you must possess in-depth knowledge of billing software and medical insurance policies. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with co-workers, management, and insurance companies will form a large portion of the job.
Responsibilities:
Utilize systems to locate insurance and patient demographic information
Moving claims through various workflows if patient information cannot be located or retrieved
Enter patient information into the claim when appropriate using data entry and attention to detail skills
Follow the QMC process and guidelines to apply appropriate modifiers and payors for the patient transport
Using the telephone to call facilities like hospice or assisted living to confirm appropriate transportation information
Moving claims to the appropriate workflow once patient, payor, and modifier information is correct
Consistently achieve or exceed the daily production metrics and quality goals
Requirements
Qualifications:
High School Diploma or equivalent is required
Certification in Medical Billing and Coding preferred but not required
2+ years of customer service experience is preferred
1+ years of experience as a Medical Biller or similar role preferred
1+ years of Revenue Cycle Management is preferred
Certified Ambulance Coder Certification, Certified Coder, and/or Ambulance Billing experience preferred
Working knowledge of health insurance verification and a basic understanding of major payor groups like Medicare, Medicaid, and commercial insurances preferred
Working knowledge of various state regulations and payor guidelines is preferred
Knowledge of commercial payor databases
Strong computer skills with a willingness to learn our billing platform
The ability to identify problems and escalate issues appropriately to the direct supervisor or manager
The ability to think independently and work as a part of a team
Ability to establish and maintain effective working relationships with patients, clients, and coworkers
Benefits:
Comprehensive & competitive benefit package
Generous 401k Company Match Program
Profit Sharing Potential
Bonus Program Potential
Flexible work schedules
Paid time off and holidays
by twochickswithasidehustle | Oct 9, 2023 | Uncategorized
Description
Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations while maximizing the capture of allowable reimbursement for each client. The commitment to adherence to both principles make QMC the partner of choice for emergency medical transportation providers.
QMC is headquartered in Pittsburgh, PA. Remote opportunities may be available for this position.
The Posting Payment Specialist oversees the intake of payments by accepting and processing billing statements and conducting audits for each billing cycle. The Posting Payment Specialist must be able to keep accurate electronic and paper records, maintain accurate billing processes, and demonstrate computer skills, attention to detail, and mathematical ability.
Responsibilities:
Pulls deposits from bank lockbox/website and remits from various websites to post payments
Runs deposit reports to make sure daily deposits are balanced
Posts all payments and denials
Maintains up-to-date knowledge of the accounts being posted, especially schedules and payers
Calls insurance companies when needed to request remits
Acts as a backup to find remits on various websites.
Requirements
Qualifications:
High school diploma or equivalent is required
Must be able to type 35+ words per minute.
Basic accounting principles and medical billing experience preferred, but not required
Basic computer knowledge, and experience with Microsoft Office products including Word, Excel, and Outlook
Customer service oriented; attention to detail, accuracy, and data entry skills
Ability to handle multiple tasks and quickly adapt to changing priorities in a fast-paced environment
Strong organizational and time-management skills
Communication skills (both written and verbal).
Benefits:
Comprehensive & competitive benefit package
Generous 401k Company Match Program
Profit Sharing Potential
Bonus Program Potential
Flexible work schedules
Paid time off and holidays
Recent Comments