Functioning in a highly strategic role to ensure strong accounts receivable processes to grow revenue, minimize risk and maximize cash flow. Works to help the company Increase revenues through serving as a Subject Matter Expert (SME) -- both internally and externally to enhance billable/reimbursable claims. Provides information to assure compliance with regulatory requirements supporting billable claims practices. Participates in product and/or regulatory strategy initiatives to coordinate documentation, compose routine correspondence, and interact with outside experts, partners and regulatory agencies, as requested. Works collaboratively with multiple departments to formulate clinical strategies to maximize eligible payments from customers/clients (includes Sales, Implementation, Pharma Account Management, Operations, Payer Account Management, Legal, Operations, Billing/Reimbursement, and Service Delivery Management).
1. Direct specialty pharmacy processes to maximize cash flow and minimize bad debt risk. Collaboratively work with cross functional leadership teams on strategic initiatives through monitoring of operational compliance, and assessment of risks. Strategize the appeal effort based on all available medical, pharmaceutical and clinical information for submission to health plan.
2. Supports Specialty pharmacy accounts receivable department compliance accountability of billing, cash application, quality control, production reporting, general month end closing, audit management, and general integration activities. Ability to provide complete and detailed documentation that allows the organization to act swiftly in documenting and resolving at risk business cases/reviews.
3. Provide Direction in Development, implementation and management of performance statistics to ensure stable billing and cash flow stream including assisting in reporting for compliance and operational progress toward established overall Corporate goals.
4. Identify best practices to share across business owners to drive improvements in performance, and achieving strong results by providing guidance to support continuous improvement of quality assurance program
5.Coordinate communications within the Corporation being updated continuously with data from multiple sources, such as internal audit, external audits and investigations.
- 8-12 years of experience with a Bachelor¿s degree in a relevant discipline or 14-18 years without
- 6-10 years of experience with a Master¿s degree
- Knowledge and experience in the specialty pharmacy disease states, and familiarity with health care or PBM industry preferred
- Professional communication in heath care
- Proficient skill level in Microsoft applications; Adaptability and willingness to learn new tools and applications
- Knowledge in insurance reimbursement, including governmental payers (Medicare/Medicaid)
- Excellent level of clinical/medical analyses and able to perform medication dose calculations
- Advanced problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
- Demonstrated ability to prioritize work load and meet multiple project deadlines
- Ability to adapt in a dynamic work environment and make independent decisions
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.
None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.
Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.
Express Scripts - 11 months ago
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.