Reimbursement Officer III

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Brief Job Description:

The State Office State Supported Living Center (SSLC) Division is seeking a Certified Pharmacy Technician/Reimbursement Officer to join an interdisciplinary team of professionals to provide clinical care to residents of the SSLC. As a Certified Pharmacy Technician/Reimbursement Officer, you will work with a dynamic group of staff and professionals who are dedicated to providing supports and services for individuals with intellectual and developmental disabilities. This is a team environment where staff clinicians collaborate to provide comprehensive care and services. To learn more about the SSLCs, see https://hhs.texas.gov/about-hhs/jobs-hhs/state-supported-living-center-opportunities.

The most important characteristic about SSLC employees is that we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence. Our vision statement is “Individuals served at State Supported Living Centers will experience the highest quality of life, supported through a comprehensive array of services designed to maximize well-being, dignity, and respect.”

Essential Job Functions (EJFs):

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Reviews and researches rejected third-party claims taking appropriate action to resolve; Works backlog of denied claims for timely resubmission; Manages assigned duties keeping up-to-date and current on all claims; Workflow grid is cleared each cycle and meets productivity criteria; Identifies specific denials including new patient overrides; Completes and submits prior authorization forms for rejected claims; Follows all applicable government regulations including HIPAA; Responds to prescription drug plan audit requests; Maintains positive relationships with facility pharmacy staff; Assists facilities with prescription drug plan selection; Other duties as deemed necessary; and Ability to work both independently and as part of a team.

Knowledge, Skills and Abilities (KSAs):

Working knowledge of CMS guidelines in regard to Medicare Part D reimbursement.

Thorough knowledge of medication dispensing systems and state and federal laws related to drug distribution. Knowledge of medical and pharmaceutical terms.

Ability to communicate orally and in writing to diverse audiences.

Ability to manage high volume workloads and meet deadlines.

Skill in operating computers and applicable software.

Registrations, Licensure Requirements or Certifications:

Pharmacy technician certification required.

Initial Screening Criteria:

Experience in pharmacy prescription claims processing and health-related account and collection work.

Working knowledge of pharmacy and medical terminology.

Graduation from a standard senior school or equivalent; pharmacy technician certification required.

Additional Information:

N/A

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.