Pharmacy Claims Specialist
4 days ago
Medix is seeking a detail-oriented and adaptable Pharmacy Claims Specialist to join our dynamic team. As a Pharmacy Claims Specialist, you will play a crucial role in ensuring timely submission of pharmacy claims, identifying coverage solutions for patients, and collaborating with healthcare providers to manage appeals.
Key Responsibilities:
- Accurately and efficiently process pharmacy claims, ensuring timely submission.
- Triage rejected claims and work to identify coverage solutions for patients.
- Initiate prior authorization requests with healthcare providers and identify the correct forms needed for different insurance companies.
- Coordinate with prescribers and medical offices to ensure accurate completion of prior authorization forms.
- Follow up on prior authorization requests, providing updates to both patients and providers.
- Collaborate with medical offices to manage Appeals.
- Serve as a resource for internal teams regarding prior authorization inquiries.
- Adhere to patient assistance program guidelines and document all findings per operational procedures.
- Maintain patient and proprietary information confidentiality.
- High school diploma or GED required (Bachelor's degree preferred).
- Minimum of one year of experience in healthcare, with pharmacy claims experience strongly preferred.
- Exceptional verbal and written communication skills.
- Technical proficiency with the ability to learn and adapt to new software.
- Strong analytical thinking and attention to detail.
- Commitment to providing top-notch patient care.
- Ability to work effectively within a team and cross-functionally.
- Contribute to meaningful work in a growing company that helps patients receive essential medications.
- Thrive in a collaborative team environment with opportunities for growth.
- Be a part of a company that values flexibility, teamwork, and innovation.
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan).
- 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
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