Pharmacy Claims Specialist
4 days ago
We are seeking a highly skilled Claims Specialist to join our team at PharMerica. As a Claims Specialist, you will be responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
Key Responsibilities:
- Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
- Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
- Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
- Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes
- Works as a team to identify, document, communicate and resolve payer/billing trends and issues
- Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans
- Prepares and maintains reports and records for processing
Requirements:
- High School Diploma or GED
- Customer Service experience
- Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference
We offer a competitive salary and benefits package, including daily pay, flexible schedules, and opportunities for advancement. If you are a motivated and detail-oriented individual with a passion for claims and billing, we encourage you to apply for this exciting opportunity.
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