Pharmacy Claims Specialist

4 days ago


Chesterfield, Missouri, United States Medix Full time
Job Summary:

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.
Requirements:
  • 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.
Why Medix?
  • 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.
Benefits:
  • 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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