Job description
Our Company:
Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!
This role is HYBRID/REMOTE.
PERKS of this Insurance Claims Specialist Opportunity:
Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
If your passion is service excellence and top-quality care come join our team and apply today! Responsibilities:
PharMerica
Overview:
Medical Insurance Claims Specialists are valuable to PharMerica. If you have medical billing experience consider continuing your career with us.
Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!
This role is HYBRID/REMOTE.
PERKS of this Insurance Claims Specialist Opportunity:
- DailyPay
- Flexible schedules
- Competitive pay
- Shift differential
- Health, dental, vision and life insurance benefits
- Company paid STD and LTD
- Tuition Assistance
- Employee Discount Program
- 401k
- Paid-time off
- Tuition reimbursement
- Non-retail/Closed-door environment
Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
If your passion is service excellence and top-quality care come join our team and apply today!
- 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.
- 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.
- Education/Learning Experience
- Required: High School graduate, GED or equivalent experience
- Desired: Associates degree, 4 year college or technical degree
- Work Experience
- Required: 1 year insurance billing experience
- Desired: Third Party Billing or collections/billing experience in the healthcare industry
- Desired: General understanding of billing requirements for Medicare Part D, Medicaid, and Commercial billing
- Desired: Understanding of revenue cycle functions within pharmacy practice or equivalent setting
Skills/Knowledge- Required: Strong Analytical Skills, Excellent time management and attention to details
- Required: Working knowledge in MS Office Products (Excel, Word) and basic computer knowledge
- Required: Comfortable making phone calls and interacting with internal/external entities
- Desired: AS400, Frameworks or QS1, Computer Systems Experience
- Licenses/Certifications
- Required: N/A
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