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.
