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Dallas, TX Full Time Posted by: Conduent Posted: Thursday, 14 January 2021
About Conduent Conduent delivers mission-critical 'services and solutions on behalf of businesses and governments - creating exceptional outcomes for its clients and the millions of people who count on them. Through people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. It's why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward. Conduent's differentiated services and solutions improve experiences for millions of people every day, including two-thirds of all ?insured patients? in the U.S., 11 million employees who use its HR Services, and nearly nine million people who travel through ?toll systems daily. Conduent's solutions deliver exceptional outcomes for its clients including $17 billion in savings from medical bill review for workers compensation claims, up to 40% efficiency increase in HR operations, and up to 40% improvement in processing costs, while driving higher end-user satisfaction. Learn more at Job Description Manager - Pharmacy Claims Recovery Responsible for the operational development and management of the recovery of Medicare Part D, Medicaid and commercial pharmacy claim overpayments identified through various audits. Manages and coordinates the recovery efforts of direct reporting staff, including but not limited to: + Manage and guide staff through the pursuit of the recovery of pharmacy claim overpayments through outreach to PBM's, insurance carrier, and hospice and dialysis facilities. + Develops effective recovery approaches and workflows to maximize recovery opportunities. + Effectively trains staff to enable them to educate payers on requirements for reimbursement of overpayments associated with coordination of benefits, including Medicare Secondary Payer requirements, as well as Hospice and ESRD drug exclusions under Medicare Part D. + Monitors all outstanding payer recoveries, staff production and quality to maximize reimbursement for clients. Experience: + Strong background in pharmacy billing concepts, including pharmacy billing and claim recovery (collection) experience. + Basic knowledge of insurance procedures, working with insurance carriers, Medicare and Medicaid. + General understanding of: + Third-party reimbursement types (ie PBM, medication assistance programs, self-pay) + Healthcare reimbursement in different settings (ie home health, long term care, home infusion, health systems, community pharmacy, and ambulatory clinics. + Eligibility for patient assistance programs (ie a 340B eligible program) + Coordination of benefits to determine each party's responsibility. + Direct carrier billing, pharmacy preferred. + Knowledgeable of applicable state and federal regulations preferred. + Familiarity with NCPDP claims, pricing matrixes and reimbursement terms. + Demonstrated understanding of CMS guidelines surrounding Medicare Part D, including Hospice and ESRD drug exclusions. + Must demonstrate leadership ability and team building skills to effectively supervise all levels of staff. + Ability to work with and empower others in a collaborative basis to ensure success of the team. + Ability to operate successfully in a matrixed environment, utilizing influence to achieve desired outcome. + Ability to effectively interface with clients in person, on the phone, and via written communication. + Ability to establish workflows, manages multiple projects, and meets necessary deadlines + Knowledge and experience in organizational effectiveness and operations management. + Minimum 3 year experience managing people. Education: Bachelor's degree, business, healthcare administration or other related field, or equivalent combination of education and experience. Certified professional biller (CPB) a plus. Closing Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy.

Dallas, TX, United States of America
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1/14/2021 11:06:06 AM

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