Career Center

Job Purpose:

The Pharmacy Reimbursement Specialist provides customer support and training for all Net-Rx services. This includes processing implementation documentation, leading one-on-one training calls, and providing customer support for incoming calls, chats and emails. In addition, the Pharmacy Reimbursement Specialist will process and analyze claims data reports in order to identify opportunities and consult with pharmacies on proper billing practices according to NCPDP standards, CMS guidelines, and contractual agreements.

Essential Duties & Responsibilities:

• Develop and maintain relationships with various stakeholders in assigned territory through account management.
• On a bi-monthly basis prepare various reports based on services subscribed to by customer.
• Engage customer through recurring scheduled calls to identify opportunities and consult on proper billing practices for contract compliance.
• Process documents to facilitate new customer implementation. This includes coordinating with customer to ensure documentation is filled out accurately and timely, sending the correct documents to the Pharmacy Benefits Manager (PBM), and ensuring Net-Rx is set-up to receive 835 files on behalf of the pharmacy. Coordinate with the Technical Support team to establish software data feeds with-in 30 days of signed agreement.
• On-Board new customers for all services subscribed to. This includes training staff on website application, reports, and best practices. Training consists of a minimum of four calls, within 120 days of received signed contract.
• Process Electronic Funds Transfer (EFT) documents on behalf of the pharmacy to facilitate payments from PBM to be deposited directly into the customer’s bank account. Monitor set-up process to ensure all payers are accurately set-up within a 120-day time period.
• Identify “at risk” accounts; engage Team Lead’s and/or Management for assistance in developing a customer retention plan for the account.
• Provide customer support through inbound calls, emails and live chat, providing quick and appropriate resolution. Must be able to navigate multiple computer applications with speed and accuracy, troubleshoot and analyze data to determine root cause, and engage appropriate team members for assistance if unable to resolve on your own.
• Document customer interaction and keep account information up to date within our CRM program.
• Promote and present Net-Rx services by recognizing up-sell opportunities, sharing expertise and promoting a positive team environment.
• Complete customer care calls to Retail accounts on a bi-yearly basis, addressing any pending issues and gauging customer satisfaction.
• Audit assigned Long Term Care accounts and umbrella corporations with 5 or more locations on a quarterly basis. Ensuring all Net-Rx databases are up to date with current account information, software data is up to date, and all eligible 835 files are being received. Completing a customer call to address any pending issues and gauge customer satisfaction.
• Manage web based downloads of 835 electronic remittance files on a daily basis to ensure customer files stay up to date. Work with Technical Support team and PBM’s to retrieve missing files, or process new PBM set-ups.
• Contribute to data entry projects and account audits in a team based environment to assist with system wide data integrity.

 Minimum Qualifications & Competencies:

• Associates Degree preferred, equal work experience taken into consideration
• Pharmacy operations, claims billing, or medical billing experience preferred.
• Have an understanding of third party contracts and billing practices in Long Term Care or Retail pharmacy environment.
• Knowledge of Microsoft Word, Excel, and Outlook required, with minimum 1-year experience using applications in professional environment.
• Understanding of web-based applications.
• Experience using Customer Relationship Management (CRM) and ticketing software.
• Minimum 1-year experience in a customer service role.
• Minimum 1-year experience working in an office environment.
• Must have strong analytical skills and attention to detail.
• Strong verbal and written communication skills.
• Ability to organize and prioritize a variety of tasks and projects.
• Ability to preserve confidentiality of information.
• Committed to providing excellent customer service.
• A strong sense of urgency to meet deadlines and complete tasks.
• A desire and aptitude to learn, master and teach.
• A positive team player, always looking to improve the department/company.
• Knowledge of brand and generic drugs by name and pharmacy dispense software a plus