Pharmacy Claims Specialist
2 weeks ago
A-Line Staffing Solutions is seeking a Pharmacy Claims Specialist. This role offers the opportunity to work with a leading organization in the healthcare sector, providing a pathway for professional advancement. This position is full-time, requiring 40+ hours per week.
Compensation and Benefits
- The hourly wage for this role is $19.00.
- Full-time employees are eligible for benefits after a specified period of employment.
- A 401(k) plan with company matching is available for employees after one year of service.
Position Highlights
- This is a contract role with the potential for permanent placement based on performance and attendance.
- The work schedule is Monday through Friday from 3:00 PM to 11:30 PM, including rotating weekends.
Key Responsibilities
- Investigate and resolve denied claims by collaborating with national Medicare D plans, third-party insurers, and state Medicaid programs to maximize reimbursement.
- Ensure claim approvals by executing necessary edits and reversals to optimize payer reimbursement.
- Monitor and address revenue risks related to payer configurations, billing, rebilling, and reversal processes.
- Collaborate with team members to identify, document, and resolve billing trends and issues.
- Review and convert billing exception reports to ensure accurate financial plan submissions.
- Maintain and prepare reports and records for processing.
- Perform additional tasks as assigned.
Qualifications
- High School Diploma or GED is required.
- Prior experience in claims adjudication is preferred.
- Consistent attendance is crucial during the initial employment period.
Preferred Skills
- Experience in long-term care settings.
- Valid pharmacy technician license in the relevant state.
If you believe this position aligns with your skills and career goals, we encourage you to explore this opportunity further.
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