A-Line Staffing is now hiring a Pharmacy Claims Specialist in West Henrietta, NY. The Pharmacy Claims Specialist would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.

If you are interested in this Pharmacy Claims Specialist position, please contact Austin Faris at 586-710-7941 afaris@alinestaffing.com.

Pharmacy Claims Specialist Compensation

• The pay for this position is $18.00 per hour.
• Benefits are available to full-time employees after 90 days of employment.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

Pharmacy Claims Specialist Highlights

• This position is a contract assignment.
• The required availability for this position is full-time hours.
• This position will not convert to a permanent role as it is a result of an unexpected leave of absence.

Pharmacy Claims Specialist Responsibilities

• Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
• Researches, analyzes, and appropriately resolves 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.
• Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
• Monitors and resolves at-risk revenue associated with payer setup, billing, rebilling, and reversal processes.
• Works as a team to identify, document, communicate, and resolve payer/billing trends and issues.
• Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans.
• Prepares and maintains reports and records for processing.
• Performs other tasks as assigned.

Pharmacy Claims Specialist Requirements

• Education/Learning Experience:
• Required: High School Diploma or GED.
• Desired: Associate’s or Bachelor’s Degree.
• Work Experience:
• Required: Customer Service.
• Desired: Up to one year of related experience. Pharmacy Technician experience.
• Skills/Knowledge:
• Required: 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.
• Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations, and trendsetters.
• Licenses/Certifications:
• Desired: Pharmacy Technician, but not required.

If you think this Pharmacy Claims Specialist position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!