Pharmacy Claims Specialist
4 days ago
We are seeking a highly skilled Pharmacy Claims Specialist to join our team. As a Pharmacy Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing for our pharmacy claims.
Responsibilities
• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
• Research, analyze, and appropriately resolve 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
• Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Monitor and resolve at-risk revenue associated with payer set up, billing, rebilling, and reversal processes
• Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
• Review and work to convert billing exception reports to ensure claims are billed to accurate financial plans
• Prepare and maintain reports and records for processing
• Perform other tasks as assigned
Requirements
• High School Diploma or GED
• Customer Service experience
• Up to one year of related experience; Pharmacy Technician experience a strong preference
• Ability to retain a large amount of information and apply that knowledge to related situations
• Ability to work in a fast-paced environment
• Basic math aptitude
• Microsoft Office Suite
About Our Company
We are a full-service pharmacy solution providing value beyond medication. We are the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations, and post-acute care organizations. We offer unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement, and the highest hiring goals in decades. For more information about us, please visit our website.
What We Offer
• DailyPay
• Flexible schedules
• Competitive pay
• Shift differential
• Health, dental, vision, and life insurance benefits
• Company-paid STD and LTD
• Tuition Assistance
• Employee Discount Program
• 401k
• Paid-time off
• Tuition reimbursement
• Non-retail/Closed-door environment
Work Environment
This is a remote position and can be worked from anywhere in the continental United States. We offer a non-retail pharmacy environment and a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients.
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