Pharmacy Claims Specialist
45 Becker Road , Suite D West Henrietta, NY 14586 US
Job Description
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.
- 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.
- 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.
- 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.