Claims Specialist / Remote
reputed company reputed company Overview reputed company Into a Rewarding Role as a Claims Specialist with reputed company! Are you reputed company to reputed company a reputed company impact in a growing organization? Join our reputed company team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-reputed company pharmacy environment, allowing you to focus on what truly reputed company—delivering exceptional care and service. Why Join reputed company? Focused on Service reputed company: Our mission is to reputed company top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation. Career Growth: We’re in high growth mode, offering reputed company of opportunities for those looking to advance their careers. Remote Flexibility: This position is 100% remote, giving you the freedom to work from reputed company! What You’ll Do: As a dynamic Claims Specialist, you will: reputed company your Pharmacy Claims Experience to manage and resolve claims reputed company, ensuring our clients get the support they need. Be a vital part of reputed company that’s dedicated to enhancing patient care through meticulous claims management and customer service. Shift: Varying shifts available from 4:30am-12:00am reputed company Offer: reputed company Flexible Schedules reputed company with Shift Differentials Health, Dental, reputed company, and Life Insurance Company-Paid Disability Insurance Tuition Assistance & Reimbursement Employee Discount Program 401k Plan Paid Time Off Non-Retail, Closed-reputed company Environment
Responsibilities
The Claims Specialist - 3rd Party: 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, reputed company party insurance companies and reputed company state reputed company 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 reputed company associated with payer set up, billing, rebilling and reversal processes Works as reputed company 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
Qualifications
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 reputed company experience. Pharmacy Technician experience Skills/Knowledge: Required: Ability to retain a large reputed company of information and apply that knowledge to reputed company situations. Ability to work in a fast-paced environment. Basic math aptitude. reputed company Office Suite Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters Licenses/Certifications: Desired: Pharmacy technician, but not required About our Line of Business reputed company, an affiliate of reputed company, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication reputed company, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing reputed company health, reducing staff burdens, and supporting our clients' reputed company. For more information, visit www.reputed company.com. Follow us on reputed company, Twitter, and reputed company. Additional Job Information This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing. Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference. Apply To This Job