As a Benefit Administration Manager, you will be part of an extremely talented team within our Client Benefits department at CerpassRx. You will lead the Benefits Coder(s) and assist with coding/system functionality while also collaborating with the Testing and Quality Assurance, Implementation and Partner Relations team members to ensure high quality support to our clients and members.
Responsibilities
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Lead BA team to ensure acceptable and appropriate quality levels and production SLA response time
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Serves as a main liaison internally and externally related to benefits
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Performance reviews and goal setting
- Ensure team members are trained
- Development plans for growth
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Develops ability to produce and analyze reports to research and resolve claims adjudication related discrepancies, errors and problems
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Makes recommendations to streamline the work processes, create efficiency, and assist with updates
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Researches plan/benefit design options and requirements as required
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Perform claim testing to ensure accurate claim adjudication
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Develops ability to evaluate claims to identify errors and adjust accordingly
Other Responsibilities
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Develops in-depth understanding of and develops ability to create and maintain plan/benefit design rules and limitations to include:
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Adjudication rules
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Clinical rules
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Payment rules
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Client management
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Plan/group management
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Analyze benefit requests and ensure appropriate implementation to claim adjudication system (i.e. copays, accumulations, drug coverage, DAW, formulary, COB, Specialty, Mail Order)
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Work with Implementations and Account Management to implement new and maintain existing benefit plans and client pricing in the claim adjudication system
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Work with Clinical to implement clinical program updates in the claim adjudication system
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Assists in developing the claims adjudication system plan/benefit design
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Uses professional knowledge in PA processing, dosage calculations, client compliance, and knowledge of medications
Requirements
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Excellent written and verbal communication skills
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Demonstrated positive interpersonal skills
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Strong organizational skills
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Ability to work independently as well as with team members
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Must be creative and resourceful, self-starter, highly motivated, critical thinker
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Ability to provide client consultation and facilitate client meetings over the phone and face to face if required
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Experience working with internal and external client team members
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Advanced use of Microsoft Office Products
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Detail oriented
Experience
- 5+ years PBM experience in Benefits Adjudication is required
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Program/project management experience preferred
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Specific experience with claims adjudication required
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Specific experience with pharmacy benefit management benefit structures required
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At least 1 year of systems development, business requirements analysis, testing, QA, project management, or other related experience in a progressive systems environment
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High School Diploma or GED Required. Bachelor’s Degree Preferred