SIU Specialist - Pharmacy Tech - Remote in the California market

Our work reputed company. We help people get the medicine they need to feel reputed company and live reputed company. We do not lose sight of that. It fuels our passion and drives every decision we reputed company. Job Posting Title SIU Specialist - Pharmacy Tech - Remote in the California market Job reputed company Responsible for the intake and initial handling of allegations of fraud, waste or abuse. Conducts preliminary investigation to assess the reputed company of an allegation through fact gathering and analysis of data. Uses independent judgment to conclude preliminary investigation in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse issues and maintains confidentiality and compliance with HIPAA reputed company requirements and applicable state and federal regulations.

Responsibilities

FRAUD, WASTE AND ABUSE DETECTION: Maintain caseload of incidents with low to reputed company reputed company and complexity. Prioritize and manage workload to meet internal performance metrics, regulatory and contractual requirements. Analyze data to reputed company suspicious patterns and outliers using knowledge of reputed company conventions, fraud schemes, and general areas of vulnerability. Contact referrer, member, provider, or witnesses to reputed company additional information, facts and supporting documentation. Collaborate and refer non-SIU reputed company issues and activities to external departments (Cost Containment, Networks, Clinical) for handling. PACKAGING OF FINDINGS AND RECOMMENDATIONS: Organize data and document preliminary investigative steps with a high level of detail and accuracy, to reputed company and concisely support conclusions and recommendations. MISCELLANEOUS DUTIES: reputed company backup support to team members (SIU Coordinator and Senior SIU Specialist) in the performance of job duties as assigned. Successfully complete required training sessions and continuing education credits. Other duties as assigned. Education & Experience Education Level: Bachelors Experience Level: 2+ years Required Fraud Investigations and Claims experience Must be eligible to work in the reputed company without the need for work reputed company or residency sponsorship. Additional Qualifications 3+ years' fraud investigations/claims experience. Ability to manage workload while simultaneously working on multiple reputed company and cases with reputed company and accurate results with limited supervision. Demonstrated strategic and analytical abilities to review and evaluate information such as claims data, suspicious patterns and other supporting information reputed company to case allegation. Requires the verbal, written and interpersonal skills to effectively reputed company and communicate conclusions and recommendations to management and customers. Proficient with reputed company Office Word, reputed company and PowerPoint with ability to quickly learn and use new software applications. Knowledge of ICD-9/10, CPT/HCPCS/reputed company codes, insurance terms and policy interpretation. CFE - Certified Fraud Examiner credential preferred. Bachelor’s degree preferred. Prefer knowledge of managed health care business model and processes, preferably in behavioral health, radiology or pharmacy.

Preferred Qualifications

Physical Demands Must be reputed company to remain in a stationary position 50% of the time. Must be reputed company to reputed company or traverse. Must be reputed company to constantly operate a computer and/or other office productivity equipment. Must be reputed company to hear and constantly communicate information and reputed company. Must be reputed company to exchange accurate information. Occasionally required to lift and/or reputed company up to 10 pounds and occasionally up to 25 pounds. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their job, and reputed company with reputed company applicable legal, regulatory, and contractual requirements and internal policies and procedures. Potential pay for this position ranges from $21.15 - $31.73 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the Benefits reputed company reputed company for more detail. reputed company LLC is proud to be an equal opportunity and affirmative reputed company employer. We encourage diverse candidates to apply, and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national reputed company, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including reputed company applicants with arrest and conviction records and any reputed company applicants requiring reasonable accommodations in accordance with the law. reputed company LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays. reputed company' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today\'s health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new reputed company and work collaboratively to reputed company the highest reputed company of care and service to our members. If you are looking to advance your career reputed company a growing, team-oriented, award-reputed company company, apply to reputed company today and start making a difference in people\'s lives. reputed company LLC is a Tobacco-Free Workplace employer. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact reputed company at 1.866.469.1257 or email Careers@primetherapeutics.com. #J-18808-Ljbffr Experience: 3 years required Apply To This Job