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Pharmacy Claims Specialist

Biloxi, MS 39530

Industry: Healthcare Job Number: LB791365418 Pay Rate: $16 / hour

Job Description

Qualifications
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The ability to utilize a personal computer and applicable department/organizational software
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The ability to exercise sound judgment and possess strong problem solving skills
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The ability to ask probing questions and obtain thorough and relevant information
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The ability to deliver highly technical information to less technical individuals
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Knowledge of the most common brand and generic drug names
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Knowledge of third party prescription claims adjudication programs and processes
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Knowledge of managed care principles and reimbursement policies and procedures
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Knowledge of basic medical terminology and understanding of National Drug Code (NDC)
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Knowledge of 340B program and regulations governing administration and compliance
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Knowledge of Mississippi Board of Pharmacy and Federal controlled substances regulations
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Must have effective verbal and written communication skills and demonstrate the ability to
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work well within a team
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Must demonstrate professional and ethical business practices, adherence to company
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standards, and a commitment to personal and professional development
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Proven time management skills and the ability to work in a production focused environment are a must
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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 have high school diploma or equivalent and 1-2 years of experience in a pharmacy setting
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Must be Nationally Certified by Pharmacy Technician Certification Board
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Knowledge and experience in Medicare Parts A & billing and in the adjudication of pharmacy claims
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Must be able to sit or stand for extended periods of time and to lift items greater than 40 pounds above shoulders
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May require frequent bending of knees and back
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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

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About Biloxi, MS

Ready to take the next step in your career? Explore our job opportunities in the vibrant Biloxi, Mississippi area. Known for its stunning Gulf Coast beaches, lively casino scene, and rich history, Biloxi offers a unique blend of Southern charm and modern opportunities. Imagine pursuing your passion while enjoying fresh Gulf seafood, exploring the Ohr-O'Keefe Museum of Art, catching a show at the Saenger Theatre, or cheering on the Biloxi Shuckers baseball team at MGM Park. With a booming economy, cultural diversity, and endless recreational activities like fishing at the Biloxi Small Craft Harbor or strolling through the beautiful Live Oaks of Beauvoir, Biloxi is a captivating place to build your career. Start your job search with us today and discover the endless possibilities that await in this enchanting Mississippi gem.

Franchise Support Center

11101 Switzer, Suite 110

Overland Park, KS 66210

(913) 562-5610

(800) 581-NEXT (6398)

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Meet Shane...

Shane s journey with Nextaff began in 2019, when he established a successful franchise in the Kansas City metro area. His experience as a Nextaff franchise owner provides prospective buyers with a completely transparent view of the Nextaff Franchise Opportunity. Prior to his time at Nextaff, Shane led large sales teams in the Financial Services and Medical Device industries, further developing his expertise in leadership and business management.

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Do you play sports?

Basketball! I was fortunate enough to play college basketball all 4 years and in 2013 we won the NCAA DII National Championship.

What do you love most about your current role?

Getting to know prospective franchise buyers. I love hearing about their goals and dreams they want to achieve through entrepreneurship.

What is your favorite color?

Orange! Yes, it is one of Nextaff s main colors but it was my favorite before coming to Nextaff. In the franchising world, I m known as Orange pants guy .

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Meet Cary...

When it comes to operating a staffing firm, Cary has worn every hat. From recruiting, to sales, to management, to ownership, he has been involved in every aspect of running a successful staffing business. He has successfully led three separate companies to the Inc. 500 and Inc. 5000 lists, which puts him in an elite class of staffing entrepreneurship. Combining that experience with a strong passion for entrepreneurs makes Cary an ideal leader for driving the Nextaff vision.

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Describe yourself in three words.

Loyal, Driven, Creative

Is there a mantra or affirmation you live by?

Do what you said you were going to do.

Do you have a celebrity doppelganger?

Back in the day, it was John Cusak. I want my two dollars!

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