•
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
•
Must possess a valid driver’s license, reliable transportation, and willingness to travel to different pharmacy locations as required
•
High school or equivalent (Required)
Responsibilities
•
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
•
Conducts routine administrative and clerical tasks such as answering the phones, filing documents, ordering supplies, stocking shelves, and processing insurance and self-pay payments
•
Assists in the administration of 340B and other medication-related patient assistance programs
•
Performs additional duties as required by supervisory personnel
•
Generating monthly statements, processing and entering payments, and reconciling third-party claims through the pharmacy data system accounts receivable
•
Assisting the Accounting Department in collecting data for claims audits
•
Serve as a subject matter expert for complicated processing for prescriptions
•
Work cross functionally with other departments and shifts with auto-billing and other queues
•
Claims adjustments and review
•
Adjudicating insurance claims and troubleshooting rejected claims
•
Ensure compliance of 340B pharmacy and third-party billing practices
•
Prescription data entry and filling of medication orders as required
•
Providing customer service through phones, checking emails and messages to pharmacy and responding promptly and professionally
•
Communication with insurance parties via inbound and outbound calls
•
Analyzing pre- and post- adjudication reports for training opportunities and compliance
•
Performs other duties as requested and/or required
•
Upholds, complies with, and enforces the Core Principles and Code of Conduct