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Senior Payer Healthcare Analyst - Specialty Pharmacy Experience - Required, Great Benefits & Pay

Company Name: Kroger Specialty Pharmacy
Position Type: Employee
FLSA Status: 

Position Summary

Liaison between RCM Team with Specialty Pharmacy Contracting and Compliance. Resolve outstanding Payor EDI ERA/EFT agreement issues resulting in payment of claims. Understand the payor agreement contracts for commercial/government agreements identify issues and work with various payers on payment resolution. Responsible for ERA/EFT setup, pricing agreement updates to CPR+ operating platform. Work with the RCM management team to build strong working relationships with appropriate contacts at each of the Commercial/Government Payors. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.

Essential Job Functions

  • Collaborate with RCM leaders, Sales leaders, and Pharmacy Operations leaders to carry out strategies for resolving active Payor-Claim and ERA/EFT issues
  • Build and maintain a positive, effective relationship with contacts at all Commercial/Government payers; coordinate meetings between payers and KSP as needed
  • Setup meetings with payer contacts to establish EDI claim billing as well as ERA/EFT
  • Identify issues that may negatively impact authorizations or payment flow that could arise in a system implementation, process changes etc. with new payer agreements
  • Audit and assess claims and resolve outstanding collection issues resulting in payment of claims relating to electronic payer setup
  • Communicate new payer contract information highlights to all RCM staff during management review meetings and create team communication reference documents
  • Travel to KSP corporate or other specified office locations based on management's request
  • Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements for payer agreements
  • Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies/procedures
  • Perform other related duties as assigned
  • Must be able to perform the essential job functions of this position with or without reasonable accommodation
  • Minimum Position Qualifications

  • High School Diploma or GED
  • Any Specialty Pharmacy Healthcare Payer EDI claim and ERA setup
  • Problem-solving skills with intake experience including claims processing, cash posting and reconciliation knowledge
  • Knowledge of accounting procedures, healthcare terminology and government and insurance billing and collections procedures including cash receipts, reconciliation and remittance posting and strong knowledge of prior authorizations and appeals
  • Comprehensive knowledge of both pharmacy and medical payer types and a good working knowledge of all aspects of electronic data setup
  • Strong team player who is organized, detail oriented and able to multitask
  • Excellent oral/written communication skills
  • Demonstrated working knowledge of D.0 and 835/837 claim formats, MS Office
  • Desired Previous Experience/Education

  • Bachelor's Degree
  • 5+ years Specialty Pharmacy experience
  • Education Level: High School Diploma/ GED Required
    Required Certifications/Licenses: None
    Position Type: Full-Time 
    Shift(s): [[mfield4]]

    States: Alabama; Arizona; Arkansas; Colorado; Connecticut; Delaware; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hampshire; New Jersey; New Mexico; New York; North Carolina; North Dakota; Ohio; Oklahoma; Oregon; Pennsylvania; Rhode Island; South Carolina; South Dakota; Tennessee; Texas; Utah; Vermont; Washington; West Virginia; Wisconsin; Wyoming
    Keywords: call center, specialty pharmacy, reimbursement, claim processing, cash posting, reconciliation


    Jobs at Kroger:  To support and reward our hardworking and friendly associates, we offer much more than just a paycheck. We strive to feed your future by offering the ingredients you need to create your own recipe for success at work and in life. Our associates receive a full plate of benefits that promote their physical, emotional and financial well-being, including access to competitive health care and retirement benefits, paid time off, mental health resources, associate discounts and opportunities to learn, grow and advance. Our associates also get to help us make a difference in our communities through our Zero Hunger | Zero Waste and Framework for Action: Diversity, Equity and Inclusion plans. Visit the to learn more about our work in the communities we serve and how our associates help us be a good neighbor.

    Below is a list of some of the benefits we offer our associates.

    Health and Well-being Benefits:

    • Health care benefits
    • Paid time off such as vacation, sick leave, and parental leave
    • Mental and emotional support resources through our Employee Assistance Program

    Financial Benefits:

    • Participation in a 401(k) plan, subject to certain eligibility requirements
    • Group term life insurance eligible
    • Eligible for an annual bonus based upon company performance
    • Associate discounts

    Growth and Development Benefits:

    • Tuition assistance, college scholarships and educational leave of absence, depending on varying criteria by location and subject to certain eligibility requirements
    • Robust internal training and development resources to grow your career

    We want the best for associates and our customers, and together, we strive to create a welcoming and engaging environment where you’ll love to work. If you are interested in becoming a valued member of our team, apply now. We look forward to getting to know you!

    Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names.  At The Kroger Co., we are Fresh for Everyone™ and dedicated to our Purpose: To Feed the Human Spirit®.  We are committed to creating #ZeroHungerZeroWaste communities by 2025.  Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.


     Posting Notes:  FL || Lake Mary || 3200 Lake Emma Drive || 32746 || Kroger Specialty Pharmacy || None || Auditing; Call Center; Finance; Specialty Pharmacy || Employee || Exempt || Full-Time || None 

    Nearest Major Market: Orlando

    Job Segment: HR, Medical, Pharmacy, Equity, Counseling, Human Resources, Healthcare, Finance

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