Pharmacy Claims Specialist

2 weeks ago


Bethlehem, Pennsylvania, United States A-Line Staffing Solutions Full time
Job Overview

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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