• Amerihealth Caritas Health Plan
  • $113,830.00 -153,620.00/year*
  • Philadelphia , PA
  • Scientific Research
  • Full-Time
  • 1103 Market St

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* 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

Associated topics: aseptic, dietary, healthcare, histology, immunoassay, medical, physiologist, therapeutic, transfection, virus

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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