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Accredo - Regulatory and Clinical Analyst RN

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POST DATE 9/17/2016
END DATE 11/1/2016

Express Scripts Orlando, FL

Orlando, FL
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree


Schedule: Full-time

Job ID: REQ20004194


This position s ideal candidate should be a Registered Nurse (BSN preferred) who has good knowledge of or can quickly learn CMS regulations affecting billing/reimbursement for specialty medications shipped to Medicare (primarily Medicare Part B, DME) patients home. The candidate should have clinical experience working as a nurse and must have excellent communication skills to be able to assist billing/reimbursement staff with clinical functions (obtain patient s medical records as required by payers medical policy, and/or review medical records to ensure that the patient meet medical criteria, and/or perform clinical appeals as needed). The candidate should also have working knowledge of Microsoft applications, including SharePoint, Outlook, Excel, and Word. Lastly, the candidate must be able to multitask and be flexible enough to work in a multi-dimensional environment.


* Performs in-depth reviews of incoming regulatory communications, analyzes requirements to Accredo s current B/R practice. Determines potential impact to company s business and sends written recommendations to the Sr. Manager

* Builds and maintains the Medicare SharePoint Site and the BR Drug Database

* Responds to internal requests for clarification and verification of new or existing guidance and communication

* Drafts and reviews clinical appeals letters, including Administrative Law Judge (ALJ) Hearing requests

* Tracks data related to denials/appeals/write-offs, and identifies trends, root-cause and make appropriate recommendations to leadership for remedies to minimize avoidable write-offs

* Performs a wide variety of other ad-hoc tasks, provides reports and minor projects as requested


* BA/BS degree and, or

* MA/MS and 0 -2 years relevant experience.

* 2 5 years of relevant experience working with Medicare/Medicaid on billing/collection/appeals required.

* Excellent PC skills, including Microsoft Excel, Access, Word, Outlook, PowerPoint, SharePoint, Project, etc.
Able to use Visio and the professional version of Acrobat/PDF.
* Detailed oriented, possesses good organizational skills, good verbal and written communication skills, good email etiquette.

* Research and analytic skills are required.

* Ability to work under pressure and meet tight deadlines.


A leading provider of specialty pharmacy services, Accredo improves care for patients through behavioral and clinical expertise.

Accredo offers a broad range of healthcare products and services for individuals with chronic health conditions, such as growth hormone deficiencies, hepatitis C, hemophilia, oncology, multiple sclerosis and rheumatoid arthritis. It also provides comprehensive patient management services, including clinical care management programs, counseling, education, outcomes measurement, social services and reimbursement services.


Advance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes.
Join the company that Fortune magazine ranked as one of the 'Most Admired Companies' in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services.
We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation.
Express Scripts is a VEVRAA Federal Contractor.

Express Scripts is an EOE
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class. None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.


One of the largest pharmacy benefits management (PBM) companies in North America, Express Scripts administers the prescription drug benefits of millions of health plan members in the US and Canada. Express Scripts processes claims for about 750 million prescriptions per year, designs drug plans, and offers such services as disease management programs and consumer drug data analysis.

Company Size:
10,000+ Employees
Health Care
Social Media:
1 Express Way
St. Louis, MO 01803
St. Louis, MO 63121

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