Job Description: SUMMARY The primary purpose of this position is to set up and maintain agencies and their associated edits in the Third Party Online (TO), Stratus/Claim Evaluation Rule Maintenance (CERM), and Third Party systems. The incumbent is also required to perform all tasks in a safe manner consistent with corporate policies and state and federal laws.
ESSENTIAL DUTIES AND RESPONSIBILITIES The associate is responsible for the functions below, in addition to other duties as assigned:
- Review incoming third-party insurance information, such as agency routings, agency terminations, and prescription plan updates; make the required changes to plan parameters within the Rite Aid Dispensing System (RADS), Stratus system, and/or Third Party Billing System; perform preliminary testing on plan changes to ensure accurate pharmacist alert messages and claims processing.
- Communicate insurance information, new prescription programs, and changes to existing programs to corporate and field associates via RADS broadcasts, SYSM, or other methods to facilitate third-party prescription processing.
- Coordinate the transition of data from old to new insurance programs, including customer moves and associated system maintenance.
- Research and resolve prescription-processing issues received from stores or the Third Party Support department.
- Validate non-authorized prescriptions dispensed by non-pharmacist IDs for the purpose of performing system tests and quality assurance checks and reverse transactions upon the completion of testing.
- Set up third party agencies, including data collection, translators, and error messages, in various systems.
- Research and resolve claim processing issues that cannot be resolved by store associates or the Third Party Support Desk.
- Interact with the Information Services (IS) department as directed for support and identification of Point of Sale (POS) issues at the store level.
- Assist the Third Party Support Desk with handling incoming calls as needed.
- Rotate on-call duties with Insurance Coordinators.
- Oversee the setup and maintenance of Local Area Clients.
- Assist with mapping third party data for data conversions.
Experience / Requirements: Other Skills, Abilities, and/or Training The following qualities are required:
- Committed to providing customer service that makes both internal and external customers feel welcome, important, and appreciated.
- Ability to preserve confidentiality of information.
- Ability and willingness to move with purpose and a strong sense of urgency.
- Accuracy and attention to detail.
- Ability to organize and prioritize a variety of tasks/projects.
- Familiarity with industry/technical terms and processes.
- Ability to work within strict time frames and resolute deadlines.
The following qualities are helpful:
- Ability to work weekends or extended days on an occasional basis.
- Typing speed of forty (40) WPM.
- Proficiency with the Microsoft ® Office Suite (Word, Excel, PowerPoint, and Access).
Plus one (1) year of experience as a pharmacy technician or working in a retail pharmacy, insurance, or medical office setting; or equivalent combination of education and experience.
High school diploma or general education degree (GED).
A little about us:
We create caring moments by delivering what matters most to our customers.