Specialty Pharmacy Claims Analyst

2 weeks ago


Louisville, Kentucky, United States Onco360 Full time
Position Overview:

We are currently looking for a Pharmacy Claims Specialist to join our dynamic team at Onco360. This role is essential in ensuring the smooth adjudication of pharmacy claims within our specialty pharmacy environment.


Work Schedule:

This is a Full-Time position with a standard workweek from Monday to Friday, focusing on evening hours.


Key Responsibilities:
  • Adjudicate pharmacy claims and meticulously review claim responses for precision.
  • Ensure that prescription claims are processed accurately in accordance with the coordination of benefits.
  • Resolve third-party rejections and obtain necessary overrides when applicable.
  • Conduct patient outreach to inform them of any delays in medication delivery due to insurance claim issues.

Customer Service Excellence:

As a Pharmacy Claims Specialist, you will practice first-call resolution to assist healthcare providers and patients with their pharmacy inquiries, providing thorough and timely responses to all requests.


Patient Setup and Claims Management:

Ensure complete and accurate patient setup in our systems, including demographic and insurance details. Adjudicate pharmacy claims for prescriptions in active workflow for various pharmacy plans, and review claim responses for accuracy before acceptance.


Insurance Coordination:

Contact insurance providers to resolve claim rejections and ensure timely shipping of medications. Perform outreach to patients or providers to reschedule medication deliveries if necessary.


Financial Responsibility:

Act as a liaison for patients regarding their financial obligations prior to shipment, addressing any discrepancies in copay amounts and collecting payments when required.


Qualifications:
  • Education: High School Diploma or GED is required; an Associate degree or equivalent is preferred.
  • Experience: A minimum of 1 year in a Pharmacy or Healthcare setting is required, with a preference for candidates with 3+ years of relevant experience.
  • Skills: Proficiency in pharmacy billing, claims resolution, and understanding of insurance processes is essential.

Behavioral Competencies:

The ideal candidate will be an independent worker with strong interpersonal skills, excellent communication abilities, and a detail-oriented approach to their work.



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