Claims Specialist

5 days ago


Taunton, Massachusetts, United States BrightSpring Health Services Full time
About the Role

We are seeking a highly skilled Claims Specialist to join our team at BrightSpring Health Services. As a Claims Specialist, you will play a critical role in ensuring our clients receive the pharmaceutical support they need.

Key Responsibilities
  • Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
  • Research, analyze, and resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines.
  • Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
  • Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes.
  • Work as a team to identify, document, communicate, and resolve payer/billing trends and issues.
  • Review and work to convert billing exception reports to ensure claims are billed to accurate financial plans.
  • Prepare and maintain reports and records for processing.
Requirements
  • High School Diploma or GED.
  • Customer Service experience.
  • Ability to retain a large amount of information and apply that knowledge to related situations.
  • Basic math aptitude.
  • Microsoft Office Suite.
About Our Company

BrightSpring Health Services is a leading provider of pharmacy services to senior living communities, skilled nursing facilities, public health organizations, and post-acute care organizations. We offer a dynamic work environment, opportunities for growth and development, and a commitment to excellence in patient care.



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