Lead Quality Reviewer

The Lead Quality Reviewer serves as the individual coordinating training for new client Electronic Medical Record (EMR), Quality Reviewers, and assisting with claims eligibility inquiries. This position compiles monthly 340B compliance reviews for distribution, as well as completes routine reviews of prescriptions to determine if established 340B eligibility has been met, communicating with the assigned 340B Account Specialist and Quality Reviewers to improve compliance and savings.

ESSENTIAL FUNCTIONS (These duties must be performed with or without reasonable accommodation. This document in no way states or implies that these are the only duties to be performed by the employee occupying this position):

• Compile and prepare monthly 340B compliance reviews for distribution to specialists for review.
• Serve as the lead reviewer for inquiries related to 340B claim eligibility.
• Act as the primary point of contact for new EMR training.
• Provide training to new 340B Quality Reviewers.
• Schedule and facilitate a monthly meeting with the 340B Quality Reviewer team to address and resolve reviewing-related issues.
• Perform reviews on a scheduled basis including resolving reconciliation issues as they arise during the monitoring and reconciliation process.
• Conduct second-level reviews of claims identified as 340B eligible by Quality Reviewers to verify accuracy.
• Review encounter, compliance, and referral claims to promote compliance and mitigate potential duplicate discount rebates or 340B diversion.
• Evaluate patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status as applicable based on company’s responsibilities to client.
• Document internal systems with required comments to improve 340B qualifying criteria through provider referrals.
• Identify and report negative trends when processing 340B qualifications, and work with appropriate internal stakeholders to resolve issues. Save
• Communicate review deficiencies and improvement opportunities to the appropriate 340B Account Specialist.
• Other duties as assigned.

Qualifications:

Education/Experience – Associate degree (AA) or equivalent from accredited two-year college or technical school and two years related experience or equivalent combination of education and experience required. Pharmacy technician certification is strongly preferred. Prior EMR experience is strongly preferred.

Communication Skills – Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Ability - Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent, and to draw and interpret bar graphs.

Reasoning Ability - Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills – MS Office Products (Excel, Word, PowerPoint, Etc.), Proficient personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, graphics, etc.

WE OFFER

At VytlOne we offer a diverse and inclusive work culture that supports a flexible work model in a collaborative, innovative team-oriented environment. You’ll  work with a mission-driven organization focused on improving healthcare outcomes
We are offering an opportunity to make a measurable impact with your work while growing your career and enjoy competitive compensation, a comprehensive health benefits package, and a supportive team environment including:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
• Company-paid basic life/AD&D, short-term and long-term disability insurance
• Rx, dental, vision, other voluntary benefits, and FSA
• Employer-matched 401k Plan
• Industry-leading PTO plan
• And more!

Apply today at:  https://www.maxor.com/careers/     

VytlOne is an EOE, including disability/vets