Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary up to $32.45 per hour
- Opportunity for career advancement and growth within the organization
- Work-from-home flexibility
- Comprehensive benefits package, including medical, dental, and vision insurance
- Supportive and collaborative work environment focused on patient-centered care
- Chance to make a positive impact on the lives of seniors in the community

What to Expect (Job Responsibilities):
- Reconcile and manage Part A claims and stays
- Perform Part D compliance tasks, including B vs D, ESRD, and Medical Necessity
- Download and review Part D and PBM reporting, taking necessary actions
- Assist in the reconciliation of Prescription Drug Event (PDE) data and manage submissions to CMS
- Coordinate with Medicare and Medicaid specialists as needed

What is Required (Qualifications):
- Minimum of 3 years working with medical and/or pharmacy claims
- Current advanced knowledge of medication names, dosages, indications, and routes of administration
- Advanced skills using Excel to manage large volumes of data, including formulas and pivot tables
- Strong attention to detail and ability to prioritize workload effectively
- Associate's degree or formal training beyond high school in lieu of an Associate's

How to Stand Out (Preferred Qualifications):
- Bachelor's degree
- Experience with EPIC EMR
- Experience managing patient plan eligibility
- Knowledge of Medicare Part D regulations and compliance requirements
- Experience in a PACE or similar healthcare program

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