Claims Specialist (Pharmacy)

  • Sector: MRS Pharmacy
  • Contact: Hemant Choudhary
  • Client: Medical Recruitment Strategies
  • Location: Uniondale, United States of America
  • Salary: Negotiable
  • Expiry Date: 30 August 2022
  • Job Ref: BBBH396559_1654110393
  • Contact Email: hchoudhary@medicalrecruitmentstrategies.com

Job Description:

  • 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, re-billing 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

Licenses/Certifications:

  • Desired: Pharmacy technician, but not required.