POSITION SUMMARY
The PBM Associate is responsible for reviewing and processing prescription drug claims in our online platform to ensure accuracy, compliance with regulations, and proper submission in a timely manner. Key duties may include verifying patient information, checking prescription details, assessing coverage eligibility, resolving billing discrepancies, and communicating with pharmacies, healthcare providers, and insurance companies to resolve issues. Strong attention to detail, knowledge of pharmacy and healthcare regulations, proficiency in computer systems, and excellent communication skills are ideal for this role.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Works closely with PBM Specialist on a daily basis.
- This position will complete a tutorial of the adjudication platforms prior to working with pharmacies and health plans.
- Verifies patient information.
- Checks prescription details.
- Assessing coverage eligibility.
- Resolves billing discrepancies.
- Communicates with pharmacies, healthcare providers, and insurance companies to resolve issues.
- Helps run monthly, quarterly, semi-annual, and annual reports.
- Assists with administrative duties.
- Majority of training is done via Zoom meetings (in-house if needed or able).
- Other duties as assigned.
EXPERIENCE, SKILLS AND EDUCATIONAL REQUIREMENTS
- High school diploma or general education degree (GED) is required.
- PTCB National Certification Education a plus.
- PACE, Medicare Part D, Retail Pharmacy experience a plus.
- Working knowledge of pharmacy insurance claims.
ADDITIONAL SKILLS AND REQUIREMENTS
- Strong attention to detail, communication and prioritization skills.
- Knowledge of pharmacy and healthcare regulations.
- Effective computer and keyboard skills.
- PC proficiency is required. Significant Microsoft Excel experience and a solid working knowledge of Microsoft Power Point and Microsoft Word are required.
- Advocates the highest ethical standards and practices.
- Maintains a positive attitude.
- Work schedule is Monday-Friday, 12:00pm-8:00pm EST, 9:00am-5:00pm PST.
Information contained in this description represents the general nature of work being performed. This is not an exhaustive list of all responsibilities, duties and skills required for the position. Reasonable accommodations will be considered in appropriate circumstances; however, as the nature of an accommodation may vary depending on the needs and desires of an individual with a disability, it is impossible to describe in advance specific accommodations that will be considered.
NOTE: Company management reserves the right to amend and revise responsibilities to meet business and organizational needs.
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