Pharmacy Claims Specialist

4 weeks ago

Eagan, Minnesota, United States Community Pharmacy, Inc. Full time

Are you passionate about problem-solving and working with insurance companies? Do you want to join a company that values its employees and offers a positive work environment? We are seeking an exceptional Claims Adjudication Specialist to join our long-term care pharmacy team.

  • Process Medicare, Medicaid, Hospice, and Insurance claims for payment.
  • Interpret claims rejections and insurance denials.
  • Contact Insurance and Hospice plans for clarification and overrides.
  • Train to be an expert in pharmacy benefits to problem-solve and resolve insurance issues.
  • Communicate with internal staff regarding claims rejections and Refill too soon outcomes.
  • Assist with DME claims adjudication.
Requirements:
  • High School Diploma or equivalent.
  • Pharmacy Technician License and National Certification required.
  • 1-year coding and insurance processing experience preferred.
  • 1-year word processing and/or data entry experience required.
  • 1-year customer service experience required.
  • Knowledge of Medicare, Medicaid, coding, and insurance processing a plus but will train.
  • Knowledge of DME claims processing a plus but will train.
  • Strong written and oral communication skills required.
  • Strong organizational and analytical skills required.
  • Must be able to actively contribute to a positive team environment.
  • Must be a self-starter with the ability to handle multiple tasks, remain focused, and work independently.
  • Must be detail-oriented and able to thrive in a fast-paced environment.
  • Only an individual who is reliable and has a solid work history will be seriously considered for the position.

This hourly position requires a schedule of Monday through Friday with a rotating schedule between the hours of 7am to 6:30pm, with rotating weekend shifts. Flexibility is a must for rotating weekday and weekend shifts.

Benefits:
  • Health Insurance.
  • Dental Insurance.
  • Vision Insurance.
  • Disability Insurance.
  • PTO.
  • 401(K) & Match.
  • Work/Life Balance.
  • Opportunity for Continuing Education.

At Community Pharmacy, Inc., we value our employees and offer a positive work environment. We are committed to making our workforce an even greater reflection of the people and communities we serve. We know it builds strength, drives innovation, and brings valuable new perspectives and energy.

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