PBM Regulatory Reporting Coordinator

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ExactCare

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

Healthcare • Healthcare Insurance • Pharmaceuticals

ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

📋 Description

• Compile Quarterly Pharmastar Compliance reports • Prepare and analyze PDE, PDE Rejections, FIR, and plan rebate reports • Assist with PACE Bid preparation and work with external auditors • Handle weekly financial billing, plan administration fees, pharmacy network payment review reporting, and related activities • Handle Action Required reporting, member authorizations, and related activities • Prepare, test, submit, and review errors in NDPDP Pharmacy Encounter data files • Perform quality assurance of existing reports and adjudication results • Review report output, identify issues, and make proactive recommendations for change • Respond to internal ticketing system requests and inquiries • Generate and update reports for clients and internal support needs • Follow HIPAA guidelines in all client communications • Maintain knowledge of plan and benefit structures, pharmacological updates, and Medicare Part D guidelines • Attend department and company meetings and educational programs as requested • Prepare Pharmastar claim audit results and disseminate summaries to clients • Perform deployment activities related to separation of duties • Communicate with providers, participants, customers, and vendors by telephone or computer

🎯 Requirements

• High School Diploma or equivalent required • Associate’s degree preferred • 1+ years of audit/quality and PACE industry experience • 2 years of Healthcare industry experience required • Health plan or insurance experience is a plus • PBM experience preferred • CPhT certification is a plus • Experience in a pharmacy support role is a plus • Current knowledge of plan and benefit structures and Medicare guidelines • Proficiency in Microsoft Excel required • Understanding of TOAD, SSRS, or T-SQL is a plus • Knowledge of government health care programs • Knowledge of pharmacology and pharmacological terms • Strong analytical and research skills • Strong computer skills, including word processors, spreadsheets, and database software • Ability to identify and resolve issues • Excellent verbal and written communication skills and professionalism with clients • Ability to multitask and prioritize projects • Ability to maintain confidentiality • Ability to work with different personality types • Strong customer focus • Ability to work an average of 40 hours per week and be available outside normal business hours on an ad-hoc basis • Applicants must be eligible to work in the United States

🏖️ Benefits

• Medical, dental, and vision coverage • Flexible spending accounts • Company-paid life insurance • Company-paid short-term disability • Voluntary benefits • 401(k) • Paid Time Off • Paid holidays • On-the-job training