Pharmacy Claims Specialist
CommuniCare Health Services
full-time
Posted on:
Location Type: Remote
Location: Maryland • Ohio • United States
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About the role
- Manage the insurance claims process
- Provide customer service to clients
- Analyze and approve claims that cannot be adjudicated
- Determine coverage and applies medical necessity guidelines
- Identify and clarify any discrepancies to assist in the adjudication process
- Ensure accurate and timely processing of rejected claims
- Work directly with third party payers for claim resolution
- Communicate with facilities on claim issues
- Resolve discrepancies and secure proper reimbursement
- Follow federal and state regulations
- Adhere to company policies and procedures
- Follow HIPPA guidelines and regulations
Requirements
- Pharmacy Tech License (required)
- Previous Long-Term Care pharmacy experience a plus (but not required)
- Knowledge of Framework LTC a plus (but not required)
Benefits
- Competitive salary commensurate with experience
- Comprehensive benefits package, including health, dental, and vision insurance
- 401(k) with company match
- Paid time off
- and more
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
customer servicecommunicationanalytical skillsproblem-solving
Certifications
Pharmacy Tech License