Analyst – Pharmacy Provider Agreement and Administration

Details

Openings 1
Location Name
Alberta Blue Cross - Edmonton
Edmonton, Alberta, CA
Date Posted Jan 02, 2018
Profession Pharmacy
Career Level(s) Entry Level, Experienced (Non Manager)
Job Type(s) Full Time, Temporary/Fixed Term
Education Level(s) Not Specified
Job ID job-9158

Position Summary

FUNCTION: 

With the support of the Team Manager, Pharmacy Provider Agreement and Administration, and under the guidance of the Senior Claims Analyst, this position is responsible for day-to-day activities related to processing manual pharmacy claims, adjusting claims, reporting on claims and managing payment summaries to pharmacies.  This is a detailed position, requiring accuracy and efficiency, to ensure that work objectives and timelines are met.   

DUTIES AND RESPONSIBILITIES: 

  • Process manual claims for payment to pharmacy providers, ensuring claims are adjudicated accurately in accordance with drug benefit plan coverage, and in a timely manner
  • Perform quality assurance checks on claim adjudication results
  • Research and analyze information to resolve inquiries or unique situations
  • Create patient/pharmacy profiles
  • Apply individual benefits to member files
  • Manage the distribution of pharmacy payment summaries
  • Track and complete reporting on work initiatives
  • Monitor individual production to ensure acceptable quantity output and timelines are met
  • Assist and educate pharmacy providers with claims submissions and reversals
  • Make suggestions to improve workflows and processes
  • Willingness to occasionally work extra hours and overtime.

SKILLS AND KNOWLEDGE:

  • Knowledge of the pharmacy industry, including drug plan design and claim adjudication standards, is an asset.
  • Demonstrated excellence in delivering superior customer service, including supporting stakeholders over the phone.
  • Strong problem solving abilities and attention to detail are critical, demonstrating the ability to use good judgment in evaluating and decision-making, and completing work with a high degree of accuracy.
  • Excellent organizational and time management skills with the ability to prioritize tasks, manage a heavy workload, and meet tight time frames.
  • Demonstrated ability to work with minimal supervision, with a strong sense of accountability, but within a team environment.
  • Demonstrated proficiency in Microsoft Word and Excel a must.  Proficiency with Microsoft Access is a definite asset.
  • Demonstrated willingness and ability to adapt to changing priorities and processes.

This position will remain open until a suitable candidate is found.  If you have the qualifications we are looking for, apply online at www.ab.bluecross.ca.


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