3rd Party Claims Specialist

  • Sector: Healthcare
  • Contact: Vaishali Sharma
  • Client: Medical Recruitment Strategies
  • Location: Taunton, United States of America
  • Salary: Negotiable
  • Expiry Date: 07 September 2022
  • Job Ref: BBBH394140_1654781392
  • Contact Email: vsharma@medicalrecruitmentstrategies.com


Mon to Fri 8:00am to 5:00pm

Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely

billing to eliminate financial risks to PharMerica and their customers.

¨ Research, analyze and appropriately resolve 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


¨ Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.

¨ Contact providers and/or customers as necessary to obtain additional information needed for claims processing.

¨ Monitor and resolve at risk revenue associated with payer set up, billing, rebilling and reversal processes.

¨ Work as a team to identify, document, communicate and resolve payer/billing trends and issues

¨ Timely complete, communicate and submit necessary payer paperwork including but not limited to benefit eligibility

assessment, claim to old overrides and manual claim forms.

¨ When necessary, will rebill claims electronically in accordance with NCPDP standards, online through payer specific

websites, manually through Universal Claim Forms, or through other approved methods for favorable resolution of

denied claims

¨ Review and work convert billing exception reports to ensure claims are billed to accurate financial plans.

¨ Complete billing transactions for non-standard order entry situations as required.

¨ Consistently meets productivity metrics and performance standards

¨ Prepares and maintains reports and records for processing.

¨ Performs other related duties as assigned

¨ Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and

Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and

applicable professional standards.