Pharmacy Claims Medicare Part B Aging Specialist, CPhT
Kroger
Pharmacy Claims Medicare Part B Aging Specialist, CPhT
Job Description
Categories : Pharmacy, Healthcare, Claims Processing, Compliance
Job Overview
The Pharmacy Claims Medicare Part B Aging Specialist, CPhT at Kroger plays a critical role in ensuring accurate processing and adjudication of Medicare Part B claims within our pharmacy operations. This position focuses on managing aging claims, resolving discrepancies, and maintaining compliance with federal regulations to support seamless pharmacy services across Kroger's network of stores and distribution centers.
Key Responsibilities
- Review and analyze aging Medicare Part B claims to identify and resolve billing errors, denials, and delays.
- Collaborate with pharmacy teams, insurance providers, and Medicare representatives to facilitate claim approvals and reimbursements.
- Utilize pharmacy management software to track claim status, update records, and generate reports on aging inventories.
- Ensure adherence to HIPAA, CMS guidelines, and Kroger's internal policies for data security and claim accuracy.
- Conduct audits of claims data, identify trends in aging issues, and recommend process improvements to reduce turnaround times.
Qualifications and Skills
Candidates must hold a valid Certified Pharmacy Technician (CPhT) certification and possess strong knowledge of Medicare Part B billing procedures. Experience in pharmacy claims processing within a retail or healthcare setting is essential. Proficiency in systems like QS/1, PioneerRx, or similar EHR platforms is required, along with excellent attention to detail and problem-solving abilities.
Work Environment
This role offers a dynamic environment in Kroger's corporate pharmacy services division, with opportunities for hybrid work arrangements depending on location. Join a team dedicated to enhancing patient care through efficient claims management and supporting Kroger's commitment to community health.
At Kroger, we value diversity and inclusion, providing comprehensive training and career growth opportunities for our associates. This position contributes directly to our mission of delivering quality pharmacy services to millions of customers nationwide.
Locations
- Hutchinson, Kansas, United States
Salary
57,750 - 82,500 USD / yearly
Source: AI Estimation
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Medicare Part B Claims Processingadvanced
- Pharmacy Billing and Adjudicationadvanced
- Claims Auditing and Resolutionintermediate
- HIPAA and CMS Complianceintermediate
- Pharmacy Management Software (e.g., QS/1)intermediate
- Data Analysis and Reportingintermediate
Required Qualifications
- Certified Pharmacy Technician (CPhT) (certification)
- 2+ years in pharmacy claims processing or billing (experience)
- Knowledge of Medicare Part B regulations (experience)
- Proficiency in pharmacy software systems (experience)
Responsibilities
- Monitor and manage aging Medicare Part B claims to ensure timely resolution and payment
- Investigate claim denials, appeals, and errors using pharmacy software and documentation
- Collaborate with pharmacists, providers, and insurers to clarify and correct claim information
- Generate reports on claims aging trends and present findings to pharmacy leadership
- Maintain accurate records and ensure compliance with all regulatory standards
- Train pharmacy staff on claims best practices and process updates
Benefits
- Health/Insurance: Comprehensive medical, dental, and vision insurance plans with low premiums
- Paid Time Off: Generous PTO, holidays, and paid parental leave
- Employee Discount: Significant discounts on groceries and merchandise at Kroger stores
- 401k: Employer-matched 401(k) retirement savings plan
- Professional Development: Tuition reimbursement and ongoing training programs
Tags & Categories
Answer 10 quick questions to check your fit for Pharmacy Claims Medicare Part B Aging Specialist, CPhT @ Kroger.
Related Books and Jobs
Pharmacy Claims Medicare Part B Aging Specialist, CPhT
Kroger
Pharmacy Claims Medicare Part B Aging Specialist, CPhT
Job Description
Categories : Pharmacy, Healthcare, Claims Processing, Compliance
Job Overview
The Pharmacy Claims Medicare Part B Aging Specialist, CPhT at Kroger plays a critical role in ensuring accurate processing and adjudication of Medicare Part B claims within our pharmacy operations. This position focuses on managing aging claims, resolving discrepancies, and maintaining compliance with federal regulations to support seamless pharmacy services across Kroger's network of stores and distribution centers.
Key Responsibilities
- Review and analyze aging Medicare Part B claims to identify and resolve billing errors, denials, and delays.
- Collaborate with pharmacy teams, insurance providers, and Medicare representatives to facilitate claim approvals and reimbursements.
- Utilize pharmacy management software to track claim status, update records, and generate reports on aging inventories.
- Ensure adherence to HIPAA, CMS guidelines, and Kroger's internal policies for data security and claim accuracy.
- Conduct audits of claims data, identify trends in aging issues, and recommend process improvements to reduce turnaround times.
Qualifications and Skills
Candidates must hold a valid Certified Pharmacy Technician (CPhT) certification and possess strong knowledge of Medicare Part B billing procedures. Experience in pharmacy claims processing within a retail or healthcare setting is essential. Proficiency in systems like QS/1, PioneerRx, or similar EHR platforms is required, along with excellent attention to detail and problem-solving abilities.
Work Environment
This role offers a dynamic environment in Kroger's corporate pharmacy services division, with opportunities for hybrid work arrangements depending on location. Join a team dedicated to enhancing patient care through efficient claims management and supporting Kroger's commitment to community health.
At Kroger, we value diversity and inclusion, providing comprehensive training and career growth opportunities for our associates. This position contributes directly to our mission of delivering quality pharmacy services to millions of customers nationwide.
Locations
- Hutchinson, Kansas, United States
Salary
57,750 - 82,500 USD / yearly
Source: AI Estimation
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Medicare Part B Claims Processingadvanced
- Pharmacy Billing and Adjudicationadvanced
- Claims Auditing and Resolutionintermediate
- HIPAA and CMS Complianceintermediate
- Pharmacy Management Software (e.g., QS/1)intermediate
- Data Analysis and Reportingintermediate
Required Qualifications
- Certified Pharmacy Technician (CPhT) (certification)
- 2+ years in pharmacy claims processing or billing (experience)
- Knowledge of Medicare Part B regulations (experience)
- Proficiency in pharmacy software systems (experience)
Responsibilities
- Monitor and manage aging Medicare Part B claims to ensure timely resolution and payment
- Investigate claim denials, appeals, and errors using pharmacy software and documentation
- Collaborate with pharmacists, providers, and insurers to clarify and correct claim information
- Generate reports on claims aging trends and present findings to pharmacy leadership
- Maintain accurate records and ensure compliance with all regulatory standards
- Train pharmacy staff on claims best practices and process updates
Benefits
- Health/Insurance: Comprehensive medical, dental, and vision insurance plans with low premiums
- Paid Time Off: Generous PTO, holidays, and paid parental leave
- Employee Discount: Significant discounts on groceries and merchandise at Kroger stores
- 401k: Employer-matched 401(k) retirement savings plan
- Professional Development: Tuition reimbursement and ongoing training programs
Tags & Categories
Answer 10 quick questions to check your fit for Pharmacy Claims Medicare Part B Aging Specialist, CPhT @ Kroger.
Related Books and Jobs