Pharmacy Claims Reconciliation Specialist (Remote, US)

About us

House Rx is on a mission to make specialty medications more affordable and accessible for patients suffering from chronic illnesses like cancer and autoimmune disorders. We provide clinics with specialized technology and support from pharmacists and care coordinators to dispense medication directly to their patients, known as medically integrated dispensing (MID). This work will directly contribute to the company’s mission of making specialty medications affordable and accessible for patients— keep reading to learn more about the role, our team, and why House Rx is the right next step in your career! Applicants must be based in the United States.

About the role

The Pharmacy Claims Reconciliation Specialist is responsible for accurately reconciling pharmacy claims data and coordinating the implementation of new processes and systems. This dual role involves analyzing large volumes of data, diagnosing discrepancies, and traveling 20-30% of the time to support implementation initiatives.

Key Responsibilities

• Data Analysis and Management:
• Mine, analyze, and organize high volumes of pharmacy claims data from various vendor tools such as Enliven, HMA, and Inmar.
• Utilize data analytics to identify trends and patterns within claims data to support reconciliation efforts.
• Claims Reconciliation:
• Perform detailed reconciliations of pharmacy claims data, ensuring accuracy and completeness.
• Diagnose issues when discrepancies arise in data matching, employing complex problem-solving skills to resolve inconsistencies.
• Pattern Recognition:
• Analyze claims data to detect unusual patterns or trends that may indicate systemic issues or opportunities for process improvements.
• Develop insights that inform operational strategies and enhance the accuracy of claims processing.
• Reporting and Documentation:
• Prepare comprehensive reports detailing reconciliation findings, identified issues, and recommendations for corrective actions.
• Maintain clear documentation of reconciliation processes and data analyses for compliance and auditing purposes.
• Quality Assurance and Compliance:
• Ensure adherence to regulatory requirements and company policies throughout the claims reconciliation process.
• Participate in quality assurance initiatives to improve overall claims accuracy and efficiency.

Implementation Coordination:

• Project Management:
• Coordinate the implementation of new pharmacy systems and processes, ensuring alignment with operational goals.
• Collaborate with cross-functional teams to develop and execute project plans.
• Training and Support:
• Provide training and support to staff during system implementations, ensuring a smooth transition.
• Travel to various locations (20-30%) to facilitate on-site training and support for new processes.
• Stakeholder Communication:
• Serve as a liaison between internal teams and external vendors to ensure successful implementation outcomes.
• Collect feedback from stakeholders to identify areas for improvement in the implementation process.
  

About you

• You have 1+ years of pharmacy claims reconciliation experience
• A unique ability to successfully problem solve for claims reconciliation
• You have exceptional organizational skills with a knack for mining through rows of data
• A background in specialty pharmacy 
• You are technology savvy with prior experience working with claims management and reconciliation tools, we use EnlivenHealth
• You are an excellent communicator and can work with technical and non-technical stakeholders across the organization
• Familiarity with pharmacy benefit management and regulatory compliance is a plus.

Expected Full-Time Base Salary:  $65,000 - $85,000
This range represents the low and high end of the anticipated base salary/wage. The actual base salary/wage will depend on several factors, including experience, knowledge, and skills. Actual compensation packages may include other elements equity, paid time off and benefits.

Why You Should Join Our Team

A career at House Rx offers the chance to work with a talented group of entrepreneurs, healthcare professionals, and technology builders who are passionate about improving specialty care and making it easier for patients to access the medication that they need.  

At House Rx, we strive to build and maintain an environment where employees from all backgrounds are valued, respected and have the opportunity to succeed. You'll find a culture that supports open communication, embracing failure as a learning opportunity, and always being open to new ideas—no matter how radical. We are a remote-first company, however, some pharmacy operations roles require onsite clinic presence. We’re committed to creating a positive and collaborative culture to achieve our mission, all while supporting our team members in all aspects of their lives—at home, at work and everywhere in between.

In particular, we offer:

• Flexible work hours and flexible paid time off
• Work remotely
• Generous parental leave
• Comprehensive healthcare, vision and dental benefits
• Competitive salary and equity stake
• We’re backed by forward-thinking investors committed to transforming healthcare, including Bessemer Venture Partners, First Round Capital, LRV Health, Khosla Ventures, Maverick Ventures, 1984.vc, and Character