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Must demonstrate the ability to manage multiple priorities or tasks, deliver timely and accurate work products with a customer service focus, and respond with urgency as required – Must perform all other duties as assigned
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Must possess a valid driver’s license, reliable transportation, and willingness to travel to different pharmacy locations as required
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High school or equivalent (Required)
Responsibilities
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Under the direct supervision of the Director of Pharmacy Services, the Pharmacy Claims Specialist is responsible for the reconciliation of pharmacy third-party claims, investigating denied, non-matched unpaid and/or underpaid claims, and posting claim reconciliation and receivables within pharmacy data system
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Conducts routine administrative and clerical tasks such as answering the phones, filing documents, ordering supplies, stocking shelves, and processing insurance and self-pay payments
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Assists in the administration of 340B and other medication-related patient assistance programs
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Performs additional duties as required by supervisory personnel
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Generating monthly statements, processing and entering payments, and reconciling third-party claims through the pharmacy data system accounts receivable
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Assisting the Accounting Department in collecting data for claims audits
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Serve as a subject matter expert for complicated processing for prescriptions
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Work cross functionally with other departments and shifts with auto-billing and other queues
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Claims adjustments and review
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Adjudicating insurance claims and troubleshooting rejected claims
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Ensure compliance of 340B pharmacy and third-party billing practices
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Prescription data entry and filling of medication orders as required
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Providing customer service through phones, checking emails and messages to pharmacy and responding promptly and professionally
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Communication with insurance parties via inbound and outbound calls
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Analyzing pre- and post- adjudication reports for training opportunities and compliance
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Performs other duties as requested and/or required
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Upholds, complies with, and enforces the Core Principles and Code of Conduct
