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Claims Specialist

2 months ago

Taunton, Massachusetts, United States BrightSpring Health Services Full time
About the Role

We are seeking a highly skilled Claims Specialist - 3rd Party to join our team at BrightSpring Health Services. 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 appropriately resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and all 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.
Requirements
  • High School Diploma or GED.
  • Customer Service experience.
  • Pharmacy Technician experience or knowledge of pharmaceuticals is 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.
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.