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.
