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Claims Specialist
2 months ago
Amerita is seeking a highly skilled Claims Specialist - 3rd Party to join our team. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.
Key Responsibilities- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
- Research, analyze, and resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans.
- 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.
- High School Diploma or GED.
- Customer Service experience.
- 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 skills.
- Associate's or Bachelor's Degree.
- Up to one year of related experience.
- Pharmacy Technician experience.
- Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations, and trendsetters.
Amerita is a full-service pharmacy solution providing value beyond medication. We offer unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement, and the highest hiring goals in decades.
