Benefit Quality Control Assistant

<strong><i>"Outstanding people are the key to our success."</i><BR>Mike Ellis, CEO, Maxor National Pharmacy Services, LLC<BR><BR>Committed to the cost-effective delivery of impactful pharmacy and healthcare services to patients and clients, Maxor is an employee-driven organization where excellence is valued, recognized and rewarded. Talented and dedicated professionals like you continue to distinguish us as a national pharmacy and healthcare service provider like no other in the industry.</strong>

US-Remote

Maxor National Pharmacy Services Company

<p>At Maxor, we&rsquo;re transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies.</p> <p>We put People First and are committed to providing outstanding service across all aspects of our business. Our goal is to create Flexible and Innovative solutions filled with inspired possibilities.<br /><br />The innovative spirit at Maxor will transform the way you think about pharmacy &amp; healthcare services. As we pave the way in a relentless commitment to positive health outcomes, it&rsquo;s never been a better time to be part of the Maxor team!<br /><br /><strong>Maxor is an EOE, including disability/vets</strong></p> https://careers-maxor.icims.com/jobs/intro?hashed=-435589753

keywords: consults,why choose maxor?,testing and validation,mentor and train,education,experience,knowledge, skills and abilities

Full Time

Overview: Maxor has an opportunity for an experienced Benefit Quality Control Assistant to join our growing pharmacy company. The benefit quality contrl assistant researches, analyzes, and designs system applications to meet the needs of an organization and integrate with existing and future systems. Consults with users to identify current operating procedures, problems, and requirements. Designs models and develops materials used for analysis and solution development including process maps and diagrams. Develops documentation and other aids for users to assist with installation, maintenance and operating procedures. May create coding and logic specifications for developers. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function.<br /><br /><strong>Our Company</strong><br /><br />We're Maxor and we're building a different kind of pharmacy company. We're transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies. We put people first and are committed to providing outstanding service across all aspects of our business. We believe there's a better way to deliver pharmacy and healthcare services to people across the country, and we'd love for you to help us do it.<br /><br /><strong>Our Locations</strong><br /><br />The Maxor workforce brings robust experience, diverse perspectives and passion from over 1,000 employees working all over the US in pharmacies, hospitals, home offices, or corporate offices. This is a remote, home-based role.
Responsibilities: <ul> <li>Testing and validation of benefits to ensure client expectations are fulfilled</li> <li>Troubleshoot and research problems or questions surrounding claims adjudication</li> <li>Creation of testing scenarios</li> <li>Documentation of testing results</li> <li>Ongoing analysis of claim samplings, validating benefit accuracy and errors</li> <li>Communicating both internally and to our clients regarding issues and inquiries</li> <li>Mentor and train others</li> <li>Knowledge of claims processing system and its surrounding systems</li> <li>Assist in testing system/code changes when necessary</li> <li>Coordinate testing of new plan benefits and changes to existing</li> <li>Serve as informational and functional liaison between the Customer Service Department and Senior System Administrator.</li> <li>Provide technical assistance to users and</li> <li>Serve as a client services team member, coordinating client needs as they relate to the Systems Administration</li> <li>Assist management in monitoring client system users&rsquo; needs and</li> <li>Maintain comprehensive knowledge of the MaxorPlus system and new plan set-up</li> <li>Actively participate in programs, committees, meetings and functions required by MaxorPlus or the Systems Administration</li> <li>Perform other job-related duties as</li> <li>Promptly report any allegations of impropriety to the Compliance</li> <li>Comply with Maxor&rsquo;s Ethical Business Conduct policy and Maxor&rsquo;s Compliance</li> <li>Remain free from exclusion under the OIG and SAMS Medicare/Medicaid</li> <li>Complete required training, as assigned, within the established timeframes.</li> <li>Must be able to cope with the mental and emotional stress of the</li> <li>Maintain regular attendance in accordance with established</li> </ul>
Requirements: <strong>Education:</strong> High School Diploma, G.E.D., or equivalent abilities and skills required. Pharmacy technician certification a plus.<br /><br /><strong>Experience:</strong> Proven analytical, communication and organizational skills.<br /><br /><strong>Knowledge, Skills and Abilities:</strong><br /><br /> <ul> <li>Experience in requirements gathering</li> <li>Ability to work in a team environment</li> <li>Effective communication skills required &ndash; including oral and in writing</li> <li>Ability to convey technical information to non-technical staff/clients</li> <li>Should be able to learn new applications/processes</li> <li>Analytical aptitude - Problem solving skills is required</li> <li>Strong organizational skills with the ability to multi-task</li> <li>May work directly with programming staff to define/test/implement business requirements</li> <li>Advanced knowledge of personal computers, including Windows Operating Systems, MS Office (Word, Excel)</li> <li>Excellent analytical skills</li> <li>Excellent verbal and written communication skills</li> <li>Ability to work on complex projects with people in diverse disciplines</li> <li>Ability to comprehend detailed specifications</li> <li>Ability to multi-task</li> <li>Ability to analyze system limitations and suggest improvements</li> <li>Working knowledge of NCPDP standards</li> </ul> <br /><strong>Why Choose Maxor?</strong><br /><br />We foster a culture that promotes teamwork; where employees are valued as the Company&rsquo;s best asset. We work hard, but we make sure to have fun along the way, too.<br /><br />We offer a competitive salary plus a great benefits package are available including: <br /><br /> <ul> <li>$750 individual, annual medical deductible</li> <li>$25 office visit copays</li> <li>Low biweekly premiums</li> <li>Company paid basic life/AD&amp;D, Short-term and Long-term disability insurance</li> <li>Rx, dental, vision, short-term disability, and FSA</li> <li>Employer-matched 401k Plan</li> <li>And more!</li> </ul> <br />The innovative spirit at Maxor will transform the way you think about pharmacy &amp; healthcare services. As we pave the way in a relentless commitment to positive health outcomes, it&rsquo;s never been a better time to be part of the Maxor team!<br /><br />Please apply online at: https://careers-maxor.icims.com/<br /><br />Maxor is an EEO/AA/M/F/Vets/Disability