CLAIMS SPECIALIST

Company: BrightSpring Health Services
Location: Hilo
Posted on: March 18, 2023

Job Description:

Our Company
PharMerica
Overview
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! -
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
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, third party insurance companies and all state Medicaid 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 revenue associated with payer set up, billing, rebilling and reversal processes
  
• Works as a team 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 related experience. Pharmacy Technician experience
      
      Skills/Knowledge:
      
      • 
        
      • Required: Ability to retain a large amount of information and apply that knowledge to related situations. Ability to work in a fast-paced environment. Basic math aptitude. Microsoft 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 BusinessPharMerica 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 is -one of the nation's -largest 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 visit -www.pharmerica.com. - Follow us on -Facebook, -Twitter, and LinkedIn.
          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.

Keywords: BrightSpring Health Services, Hilo , CLAIMS SPECIALIST, Other , Hilo, Hawaii