* Run & prepare ad hoc and standard reports for Clinical Services, including: FM, DUR, DTM, PA, Specialty, Recipient Restriction and Hemophilia, audit reports.
* Gather and summarize data using appropriate software applications and disseminate to appropriate areas.
* Manages Projects Plans and getting status updates.
* Audits high dollar claims for appropriate billing.
* Track accomplishments and delays in operational productivity improvements within Clinical Services
* Identifies potential billing irregularities, trends in billing, and provide information to the appropriate resources including Provider Network Management, Operations, and Fraud & Abuse.
* Cooperates with others to achieve departmental goals, interdepartmental relations and public relations.
* Projects an image of professionalism in appearance and conduct.
* Maintains confidentiality of all documents and conversations, respecting the dignity and privacy of all members, providers, and employees.
* Continual maintenance and assurance of interactive files that resembles a website in PerformHelp Prior Authorization application.
* Builds and develops required Access databases including tracking and analysis through queries, reports and data mining. Summarizes the data as specified to meet requirements; sets up information in Excel and validate results.
* Run test claims for the Clinical Services Department utilizing Argus Rx Focus II and/or IPNS as necessary.
* Performs other job related duties and projects as assigned.
* High School Diploma or equivalent required
* Bachelor's degree preferred
* Current National Pharmacy Technician Certification (PTCB, NCCT or ExCPT) required
* Current/recent experience creating Microsoft Access databases required