Senior Pharmacy Revenue Reconciliation Manager

Job title: Senior Pharmacy Revenue Reconciliation Manager

Company: Centene


Job description: You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position Purpose: Acts as a subject matter expert on the process of reconciling contractual reimbursement and benefit verification between finance and operations. Ensures timely claims submissions, accurate reporting, process improvement and the ability to work collaboratively on the reconciliation processes to ensure we receive the appropriate medication, supplies and service reimbursement. Ownership for all aspects of the reconciliation process and the timely resolution for all outstanding discrepancies, reduction of bad debt and operational model architecture will fall under this position. Works very closely with the Markets, Accounting, Operations, and IT partners within the AcariaHealth/Pharmacy Team and develop business contacts as deemed appropriate. Reviews work done by other team members, assists with coaching and training other associates and provides direct support the Senior Leadership Team.

• Builds cross functional teams and processes between operations and finance to drive operational and financial efficiencies and RCM optimization
• Implements policy and technology enhancements to increase successful, and timeliness to capture of revenue
• Architect operational design and oversee key team members responsible for the verification and collection of extremenly high dollar medication claims
• Acts as a Lead in various committees responsible for the oversight and improvement of claims collection and verification functions
• Multi-tasks using multiple internal and external applications to identify and research monthly premium discrepancies between expected premium and actual payments, with minimal supervision. Maybe not this one or change to ‘Uses applications and technology to research discrepancies between expected and actual reimbursement rates
• Downloads reconciliation results into management reporting tools and performs the tracking, research and resolution of identified discrepancies.
• Engages in membership eligibility research, requiring critical thinking skills and the ability to analyze and resolve payment discrepancies, to maximize the collection of accurate revenue.
• Quantifies and documents revenue implications of payment discrepancies.
• Prepares detail and summary level reports including written interpretation of analytic results.
• Contributes to the development and documentation of reconciliation workflows and educational tools used to facilitate cross-training and internal controls. Provides review/coaching/training functions as needed for other associates.
• Develops relationships with key members of other AcariaHealth departments to communicate errors/issues in a timely manner.
• Responsible for teaming with the business and operations units to identify trend outliers and performs the work necessary to facilitate discussion and possible solutions.
• Provides independent appraisals, analysis, observations and communicates issues clearly and confidently with management and other departments.
• Provides reporting and ad hoc query analysis. Makes recommendations for reporting, process or operational improvements and drives for implementation
• Assists management on team decisions such as work load distribution, timing of specific processes, and associate development suggestions.

Education/Experience: Required A Bachelor’s Degree in related field. Preferred Master’s Degree in Business Administration. Required 7+ years of experience in a related financial analysis role supporting business departments for pharmacy and medical claims. Preferred 5+ years of experience in a Specialty Pharmacy environmentPay Range: $84,300.00 – $151,700.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Expected salary: $84300 – 151700 per year

Location: USA

Job date: Mon, 04 Nov 2024 03:51:18 GMT

To help us track our recruitment effort, please indicate in your email/cover letter where (jobsnear.pro) you saw this job posting.Thanks&Good Luck