Taunton, MA - 3rd Party Claims Specialist - B&C - 33256

  • Sector: MRS Pharmacy
  • Contact: Jessa Amor Carpio
  • Duration: 1-12month
  • Start Date: 05/16/2022
  • Client: Medical Recruitment Strategies
  • Location: Massachusetts, United States of America
  • Salary: Negotiable
  • Expiry Date: 21 November 2022
  • Job Ref: BBBH394140_1661290992
  • Contact Email: jcarpio@medicalrecruitmentstrategies.com

Job Responsibilities

  • 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 deadlines.
  • 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.