Liviniti

Operations

• Claims Processing & Quality Review Process, load, and quality review incoming vendor claims submissions across multiple vendors, ensuring accuracy and adherence to strict processing timelines
• Claims Reconciliation & Issue Resolution Reconcile vendor claim files against internal processing records, payment files, remittance reports, and outstanding vendor balances
• Claims Aging, Reporting & Escalation Track claims received, claims processed, claims rejected, claims pending, and claims resolved
• Vendor & Cross-Functional Collaboration Maintain consistent communication with vendors and stakeholders throughout the claims lifecycle
• Process Improvement & Documentation Support the development and maintenance of standard operating procedures, trackers, and reporting tools related to vendor claims processing and reconciliation
• Compliance & Confidentiality Maintain confidentiality of sensitive medical information and comply with HIPAA Privacy and Security Rules

Claims Operations Analyst

Bookkeeper

• Works closely with Accounting Team members under the general supervision of the Accounting Administrator.
• Provides support with Accounts Receivable, Accounts Payable, and vendor documentation and data maintenance.
• Ensures administrative details are completed.
• Assists in the preparation of invoices and verification of accuracy.
• Submits invoices and backup documentation to clients via electronic data interchange.
• Sends 15-day payment reminders to clients related to late invoice payments.
• Reconciles Accounts Receivable payments with invoices.
• Performs research related to pharmacy claim, payment and remit questions from clients and vendors.
• Maintains records necessary for 1099 compliance.
• Proactively communicates to ensure issues and workflow priorities remain on target.

Accounting Assistant

Compliance

• Build and Implement the Compliance Function
• Own and maintain a state-by-state regulatory inventory and monitoring process
• Partner with operations and technology to implement requirements in areas such as claims adjudication, MAC pricing, pharmacy network standards, and appeals processes
• Build and maintain a continuous state of market conduct exam readiness
• Conduct internal readiness reviews and mock exams
• Design and implement system-based compliance controls and automated edits within PBM platforms
• Oversee PBM responsibilities under the Consolidated Appropriations Act (CAA)
• Provide executive leadership for the organization’s HIPAA Privacy, Security, and Breach Notification compliance programs
• Serve as executive lead for HIPAA-related incidents, overseeing intake, investigation, risk assessment, and breach determination
• Operate as a hands-on leader, directly owning key deliverables in early stages
• Build and scale the compliance team over time
• Provide regular reporting and insight to executive leadership

Vice President, PBM Compliance, Regulatory Operations

Account Executive

• The Account Executive’s primary duty is to maintain and expand relationships with the Company’s customers, vendors, and internal and external contacts to ensure needs and expectations are met and business is retained.
• Establish and maintain goodwill.
• Develop productive and professional relationships with customers and their associated vendors.
• Work independently giving great attention to detail and displaying the initiative to prevent and resolve issues.
• Serve as a superior problem solver.
• Perform duties with a strong degree of organization/prioritization skills and understanding overall business goals.
• Follow through on all tasks to the point of resolution in an educated, accurate, and timely fashion.
• Collaborate with team members to ensure a smooth customer experience.
• Coordinate internal and external resources, to meet account performance objectives.
• Proactively lead the account management process fostering and developing an effective team environment.
• Responsible for overall growth, retention, and strategic planning for accounts.
• Such responsibilities include assisting in securing new accounts, managing the onboarding processes, promoting new products and solutions to customers, delivering and interpreting reports, consulting with customers by phone or in person, and communicating needs of the customer to other team members.
• Make certain the timelines of project implementation are met.
• Maintain client satisfaction throughout plan implementation, post-implementation and all other related service activities.
• Conduct benefit review presentations.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).

Account Executive – PBM

Account Manager

• The Director of Account Management’s primary duty is a trusted advisor to the client and possesses strong business management skills.
• This individual is responsible for overseeing all client accounts, leading and mentoring the account management team, and driving organic and new business growth.
• In this role, you will maintain strategic relationships and help to guide our clients with the knowledge and solutions appropriate for their business, industry and trends.
• Establish departmental goals for service delivery measured through key performance indicators (KPI’s).
• Evaluates team’s performance against the KPI’s and intervenes with management direction to assist account management team meet and exceed goals.
• Develop and ensure that the Account Management department standards, methods, and process and procedures for client service are followed.