RCO-Advanced Claims Review Specialist
2 weeks ago
Overview:
PharmScript is one of the nation's leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients.
When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most.
Job Summary:
We're looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department.
As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary.
The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential.Responsibilities:
Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner
Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior
Prioritize your work activities daily
Timely response to all customer inquiries, both inbound and outbound prior
Responsible for working with nursing facilities/customer service representative to review charges related insurance
Qualifications:
High school degree
Must possess or be willing to apply for NJ Pharmacy Technician license
Previous experience working with Long-term care facilities preferred
Able to work independently as well as in a diverse, team environment
Reliable, able to work under pressure and meet deadlines
Excellent communication skills, professional demeanor
Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances
Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items
Physical Demands and Work Environment:
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
May be necessary to work extended hours as needed
May lift and/or move up to 25 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Knowledge, Skills, and Abilities:
Able to identify and resolve issues quickly and efficiently
Excellent communication, problem solving and organizational skills
Comfortable working independently as well as in a diverse, team environment
Able to work under pressure and meet deadlines
Strong customer service skills
Ability to lift and/or move up to 25 pounds
Strong analytical problem solving and strategic thinking skills
Excellent interpersonal skills
Basic computer skills and proficient in Microsoft Office
Moderate to advanced computer skills required
Ability to work at a moderate speed
Must possess strong telephone communication skills and etiquette
Detail oriented, excellent organizational skills
We Offer:
PharmScript offers a robust suite of benefits to support employees and their families.
Health and Wellness Benefits
Medical, Prescription Drug, Dental, and Vision coverage for you and your eligible dependents
Maternity care program and infertility services
Tax-favored Health Savings Accounts, Healthcare, and Dependent Care Flexible Spending Accounts.
EAP Assistance Program with 24/7 access to free counseling, legal guidance, and financial resources
Paid Time Off and Holidays
15 PTO days annually and 6 paid/floating holidays
Retirement Planning
401(k) retirement planning with company match
Commuter Benefits
Transit/Parking Spending Account
Voluntary Benefits
Employee Life and Accidental Death & Dismemberment, Short/Long-term Disability, Critical Illness, Accident, and Hospital Indemnity plans are available for you and eligible dependents,
Other Perks and Benefits
Legal & Identity Theft Protection Programs
Employee Discounts:
Instant savings on hundreds of products and services
Pet Insurance
Employee Support Program to eligible employees in times of urgent need
Pay Transparency:
To reinforce our commitment to fair and equal pay transparency, PharmScript's compensation is based on multiple non-discriminatory, individualized factors including but not limited to experience, job-related knowledge, education, skills, and office/market location.
EEO Statement:
PharmScript is fully committed to employing a diverse workforce.
We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law.
EO/Minorities/Females/Disabled/VeteransMin:
USD $18.00/Hr.
Max:
USD $20.00/Hr.
-
Rco-advanced Claims Review Specialist
2 weeks ago
Somerset, United States PharmScript, LLC Full timeOverview: PharmScript is one of the nation’s leading pharmacies, partnering with long-term and post - acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to...
-
RCO Senior Business Support Specialist
2 weeks ago
Somerset, United States Pharmscript Full timeOverview PharmScript is one of the nation's leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those...
-
Claims Specialist
1 week ago
Jersey City, United States Combined Insurance Full timeThe Claim Specialist, under moderate direction from the manager, investigates and settles claims promptly, equitably, and within established best practices guidelines. **Scope** - Responsible for investigating; settling high exposure, high risk Employment Practices Claims. - Ensure a high level of customer service and claim file quality. - Identifying and...
-
Claim Specialist
4 weeks ago
Jersey City, United States Combined Insurance Full timeThe Claim Specialist, under moderate direction from the manager, investigates and settles claims promptly, equitably, and within established best practices guidelines. - Responsible for investigating; settling high exposure, high risk Employment Practices Claims. - Ensure a high level of customer service and claim file quality. - Identifying and evaluating...
-
Team Lead, Inpatient Claims Pricing Specialist
2 weeks ago
New York, United States Med Review Inc Full timePosition Summary At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems,...
-
New York, United States Med Review Inc Full timePosition Summary At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems,...
-
New York, United States Med Review Inc Full timePosition Summary At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems,...
-
Claim Specialist
4 weeks ago
Jersey City, United States Chubb Full timeThe Claim Specialist, under moderate direction from the manager, investigates and settles claims promptly, equitably, and within established best practices guidelines. - Responsible for investigating; settling high exposure, high risk Employment Practices Claims. - Ensure a high level of customer service and claim file quality. - Identifying and evaluating...
-
Claims Specialist
1 month ago
New Orleans, United States Marsh McLennan Agency Full timeClaims SpecialistSUMMARY: As a Claims Specialist for the Marsh McLennan Agency, you will be an expert claims consultant providing oversight and advocacy on behalf of Business Insureds throughout the process of a loss event and the life of a claim. Duties include: You will submit claims or provide guidance on claim submission;Review coverages and resolve...
-
Claims Specialist
4 weeks ago
New Orleans, United States Marsh McLennan Agency Full timeClaims SpecialistSUMMARY: As a Claims Specialist for the Marsh McLennan Agency, you will be an expert claims consultant providing oversight and advocacy on behalf of Business Insureds throughout the process of a loss event and the life of a claim. Duties include: You will submit claims or provide guidance on claim submission;Review coverages and resolve...
-
Claims Specialist
2 weeks ago
New Orleans, Louisiana, United States Marsh McLennan Agency Full timeClaims SpecialistSUMMARY: As a Claims Specialist for the Marsh McLennan Agency, you will be an expert claims consultant providing oversight and advocacy on behalf of Business Insureds throughout the process of a loss event and the life of a claim. Duties include: You will submit claims or provide guidance on claim submission;Review coverages and resolve...
-
Claims Resolution Specialist
4 weeks ago
Jersey City, United States Caduceus Inc Full timeJob DescriptionJob DescriptionOverview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years.Conduct AR Follow-up both on front end scrubs and back end denials...
-
Claims Specialist
4 weeks ago
New York, United States Unavailable Full timeOverview About Suffolk Suffolk is a national enterprise that builds, innovates, and invests. Suffolk is an end-to-end business that provides value throughout the entire project lifecycle by leveraging its core construction management services with vertical service lines that include real estate capital investment, design, self-perform construction services,...
-
Claims Specialist
2 weeks ago
New Hyde Park, United States IPRO Full timeAs the Claims Specialist you will coordinate activities critical to the successful completion of clinical reviews projects. You will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking deliverables and deadlines, and develop project frameworks to support interdisciplinary and...
-
Medical Claim/Bill Reviewer
2 weeks ago
New York, United States Alaffia Health Full timeAbout Alaffia & Our MissionEach year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we’re on a mission to change that. We’ve assembled a team of clinicians, AI/ML engineers, and product experts to build advanced AI that finally bends the cost curve for all...
-
Claims Specialist Ii
4 days ago
New York, United States Aon Corporation Full timePosting Description: **Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your experience with a globally respected firm, this may be the next step in your career!** **How this role is different**: Our leaders pride themselves in outlining growth paths for our colleagues and helping colleagues reach...
-
Claims Specialist Ii
5 days ago
New York, United States Aon Corporation Full timePosting Description: **Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your experience with a globally respected firm, this may be the next step in your career!** **How this role is different**: Our leaders pride themselves in outlining growth paths for our colleagues and helping colleagues reach...
-
Claims Specialist
3 weeks ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a great plaintiff law firm. This opportunity is full time and hybrid out of New York, NY. Hours: 9:30am - 5:30pm, overtime when necessary Responsibilities Format documents and communications for clients; review documents (release/document verification) for production to defense counsel for...
-
Claims Specialist
2 weeks ago
New York, New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a great plaintiff law firm. This opportunity is full time and hybrid out of New York, NY. Hours: 9:30am - 5:30pm, overtime when necessary Responsibilities Format documents and communications for clients; review documents (release/document verification) for production to defense counsel for...
-
Claims Specialist
4 weeks ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a great plaintiff law firm. This opportunity is full time and hybrid out of New York, NY. Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
