KPH Healthcare Services

  • Reimbursement Analyst

    Job Locations US-NY-E Syracuse
    Posted Date 3 weeks ago(12/27/2018 8:55 AM)
    Requisition ID
    # of Openings
    Information Technology
    US-NY-E Syracuse
  • Overview

    Scope of Responsibilities: Works under minimal supervision within the Accounting and Finance department collecting and analyzing pharmacy claim data. The analyst prepares reports and maintains various files and information for the department ensuring proper reimbursement is received.


    Job Summary: Interpret data, analyze results using statistical techniques and provide ongoing reports. The candidate will turn data into information, information into insight and insight into business decisions.



    Job Duties:

    • Acquire data from primary or secondary data sources and maintain databases/data systems
    • Identify, analyze, and interpret trends or patterns in complex data sets
    • Filter and “clean” data by reviewing computer reports, printouts, and performance indicators to locate and correct code problems
    • Work with management to prioritize business and information needs
    • Locate and define new process improvement opportunities
    • In depth knowledge of SQL Queries and data pulling.
    • Building reports in SSRS report writer.
    • Develop third party reports though the use of Micro Strategy, Crystal, and Sequel BI tools to help evaluate and analyze third party insurance plans.
    • Evaluate and analyze pharmacy claims were reimbursed is below desired margin.
    • Responsible for PBM related billing communications regarding better reimbursement strategies and issues faced to all locations.
    • Responsible for auditing plans to verify contractual compliance
    • Responsible for monitoring MAC pricing and submitting MAC appeals daily and developing and maintaining MAC reporting and analysis.
    • Collaborate with pharmacy operations to identify items with increased cost, determine which payers will reimburse us below desired rate and submit appeal for reimbursement increase.
    • Analyze facility contract pricing to identify any potential problems and resolve any issues.
    • Responsible for reviewing, identifying and correcting billing issues based on contractual agreements.
    • Responsible for completing all mandatory and regulatory training programs
    • Perform other duties as assigned


    Attendance Requirements:

    Must be available, and on-time for scheduled work shifts


    Experience Preferred:

    • Previous experience in store pharmacy operations, Third Party operations, and/or Administrative Assistant duties
    • SQL


    Educational Requirements:

    • Preferred: AS Degree or Higher in Business Administration, Accounting, Finance, or related field


    Special Conditions of Employment:

    • Criminal background check and/or drug test
    • Initial and continuous exclusion and sanction/disciplinary monitoring


    Required Training:

    • HIPPA Privacy Course
    • HIPPA Security Course


    Job Skills Required:   

    • Strong communication skills
    • Basic understanding of Pharmacy computer system and Third-Party Functionality.
    • Strong organizational skills with an emphasis on detail
    • PC Computer and keyboarding skills



    Behavioral Traits Required:

    • Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and others you are in contact with
    • Initiative: Must be able to see opportunities, develop and implement creative solutions to complex problems and assume additional responsibilities
    • Flexibility: Must be willing to work variable work schedules, have the ability to adapt to changing business needs, to balance multiple priorities and deliver under pressure.
    • Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences
    • Involvement: Driven to achieve goals, objectives and results. Enjoy the demands of the job and work with interest and enthusiasm that fosters a culture of continuous improvement.
    • Customer Service: Must provide appropriate customer service (for Kinney customers, fellow employees and business partners), listen attentively to their needs and respond appropriately
    • Safety: Must take care of equipment and employ good safety habits
    • Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams


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