ADJUDICATION CLAIMS SPECIALIST II
Job Locations
US-WA-VANCOUVER
ID |
2022-75505
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Line of Business |
PharMerica
|
Position Type |
Full-Time
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Our Company
Overview
***$1,500 Sign On and Retention Bonus!*** 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! SHIFT: 8am to 4:30pm, M-F We offer: 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!
Responsibilities
* 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. * Make outbound phone calls to providers and/or customers as necessary to obtain additional information. * 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. * Research, analyze and appropriately resolve non-traditional and Post Consumption Billing 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. * Provides mentorship to less experienced staff and assists with training of new employees, as requested by Supervisor * Provide education to management and team members on payer specific claim processing rules, reimbursement, and other policy guidelines as gleaned by, and confirmed through working directly with payers * Consistently meets productivity metrics and performance standards * Prepares and maintains reports and records for processing. * Takes initiative to find opportunities and make suggestions for process improvement within the department * 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.
Qualifications
Education/Learning Experience * Required: High School graduate, GED or equivalent experience * Desired: Associates degree, 4 year college or technical degree Work Experience * Required: 2+ years insurance billing experience * Required: Specialized understanding of billing requirements in one of the following areas: Medicare Part D, Medicaid, and Commercial billing * Required: 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 * Desired: Pharmacy Technician Behavior Competencies * Required: Communication, Problem Solving, Detail Oriented and Teamwork, Customer Service, and Accuracy. * Required: Strong organization skills, self-starter, and confidence.
About our Line of Business
PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica isone of the nation'slargest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visitwww.pharmerica.com. Follow us onFacebook,Twitter, and LinkedIn.
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