Phoenix Johnson Email & Phone Number

Remote

· defines the sales product strategy for single or multiple lines of business · Collaborate closely with business leaders, marketing, and finance to ensure effective, strategic, and competitive sales plans· Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas· Ensuring the communication and contracts are up to date with each PBM· Assisting to financial analytics team with rates and discount rate verification with PBMs

Work At Home

· Audits loaded provider records for quality and financial accuracy and provide documented feedback using strong attention to detail.· Assists in configuration issues and loading of provider information, as needed.· Assists in training current staff and new hires, as necessary.· Generates and distributes Network Related Compliance/Regulatory/Accreditation reports.· Generates Provider Related reports to facilitate and support Provider Services/Provider Problem Research & Resolution.· QNXT configuration for provider contracts

Remote

· Process Member Request such as enrollment, plan changes, organization determinations· Providing support to supervisors, and representatives

· Use Microsoft Excel to process error reports· Reviewing pharmacy claims in Pahub that were input by HCPR Reimbursement Team · Using Microsoft Access to input errors that are located

· Process claims for reimbursement for Humana clinical pharmacy review received in Customer Care Portal · Input the claims from the member into Pahub· Ensure reimbursement claims are processed correctly in RX Nova

Louisville, Kentucky Area

· Process appeals that are received in Guidance Care Portal · Ensure appeals were expedited using Microsoft Outlook· Appeals were input into Pahub and once reviewed by RPh authorizations and/or letters were sent to members using Agadia

Louisville, Kentucky Area

· Receiving phone calls for Humana clinical pharmacy review and or prior authorizations faxes from members, and providers in Pahub· Ensuring that requests were sent to the correct queue in Pahub · Reviewing claims that were processed incorrectly· Inputting authorizations for approved claims · Using verbal and written skills to receive the appropriate decision for the member

Bachelor Of Science - Bs, Health/Health Care Administration/Management

Associate'S Degree, Business Administration And Management, General

High School Diploma

Pharmacy, Pre-Pharmacy Studies

Obtaining my pre-requisites for pharmacy school