Engagement Description - Responsible for assisting Medicare Advantage PPO, HMO and PDP plans meet CMS compliance requirements for PBM oversight, claims processing, CMS reporting and benefit set up and testing. Job responsibilities include Perform a quality review of claims to ensure overall quality, Assist Customer Service with questions and clearly communicates responses to inquiries, participates in systems testing, develops procedures/controls, and provides recommendations for the ongoing improvement of the updated process.
Top 3 Required Skills/Experience -
• Knowledge of pharmacy claim processing and Medicare guidance related to Part D products.
• Knowledge of pharmacy processes and the ability to assist pharmacies with claims processing.
• Analytical, organizational planning and problem-solving skills
Required Skills/Experience -
• Ability to research claims processing concerns and escalate any concerns.
• Knowledge of Network pharmacy claims processes and ability to assist pharmacies with claims submission.
• Maintains a comprehensive knowledge of the HMO, PPO and PDP products.
• Ability to participate in group or committee discussions.
Preferred Skills/Experience - Two (2) to four (4) years' experience as a pharmacy technician or customer service-related field. Experience with Microsoft Office applications including Excel, Word and Outlook. Must have data analysis, and problem resolution skills.
Bachelor's degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required.About Kyyba:
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.
At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.
Kyyba is an Equal Opportunity Employer.
Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.
Medical, dental, vision
Voluntary life and disability insurance
Optional Pre-paid legal plan
Optional Identity theft plan
Optional Medical and dependent FSA
Opportunity for advancement
Long-term assignment with opportunity for hire by client
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