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About the role
Key responsibilities & impact- Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need.
- Be a vital part of a team that’s dedicated to enhancing patient care through meticulous claims management and customer service.
- 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 set up, 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.
Requirements
What you’ll need- High School Diploma or GED
- Desired: Associate’s or Bachelor’s Degree
- Required: Customer Service
- Desired: Up to one year of related experience.
- Pharmacy Technician experience
- 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
- Desired: Pharmacy technician, but not required.
Benefits
Comp & perks- DailyPay
- Flexible Schedules
- Competitive Pay with Shift Differentials
- Health, Dental, Vision, and Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Pharmacy Claims ExperienceClaims ManagementPayer ReimbursementBillingRebillingClaims ResolutionData AnalysisReport PreparationBasic Math Aptitude
Soft Skills
Customer ServiceTeam CollaborationProblem SolvingAttention to DetailAbility to Work in Fast-Paced EnvironmentInformation Retention
Certifications
High School DiplomaGEDPharmacy Technician (Desired)