Nashville, United States
about 1 year ago
Responsible for performing Medicare Pharmacy Benefit set up validation audits and monitoring specific measures such as reviewingbenefit grids for accuracy. Assist with creation of BenefitTesting scenariosfor readiness testing Assist with validating Pharmacy benefits during testing and go-live review Ensure Medicare Pharamcy Claim Benefits are set up and working appropriately Ensure issues are identified and are submitted for correction
Audits and reviews the accuracy of pharmacy claim processing activities such as:validating benefit set up within the pharmacy claim system. Responsible for validatingstructure and benefits by validating selected claims, identifying errors and monitor and track to resolution.
Delivers specific delegated tasks assigned by a supervisor in the Quality Assurance/Audit job family. Completes day-to-day Quality Review and Audit tasks without immediate supervision, but has ready access to advice from more experienced team members. May assist in more complex audits where experience and wider business acumen is required. Contributes to the development of audit policies and procedures. Tasks involve a degree of forward planning and anticipation of needs/issues.