3rd Party Claims Specialist

  • Sector: Healthcare
  • Contact: Vaishali Sharma
  • Client: Medical Recruitment Strategies
  • Location: Uniondale, United States of America
  • Salary: Negotiable
  • Expiry Date: 03 October 2022
  • Job Ref: BBBH396559_1657062748
  • Contact Email: vsharma@medicalrecruitmentstrategies.com

Job Type: Contract



Position Summary:

  • 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



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

Shift Hours:Tuesday through Saturday; TUES, WED, FRI 11-7PM THURS 12-8PM and Saturday 9AM-6PM (1hr break)

Thanks and Regards,