RCO-Advanced Claims Review Specialist
Overview
PharmScript is one of the nations leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most.
Job Summary
Were looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department. As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential.
Responsibilities
Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner
Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior
Prioritize your work activities daily
Timely response to all customer inquiries, both inbound and outbound prior
Responsible for working with nursing facilities/customer service representative to review charges related insurance
Qualifications
High school degree
Must possess or be willing to apply for NJ Pharmacy Technician license
Previous experience working with Long-term care facilities preferred
Able to work independently as well as in a diverse, team environment
Reliable, able to work under pressure and meet deadlines
Excellent communication skills, professional demeanor
Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances
Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items
Physical Demands and Work Environment
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
May be necessary to work extended hours as needed
May lift and/or move up to 25 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Knowledge, Skills, and Abilities
Able to identify and resolve issues quickly and efficiently
Excellent communication, problem solving and organizational skills
Comfortable working independently as well as in a diverse, team environment
Able to work under pressure and meet deadlines
Strong customer service skills
Ability to lift and/or move up to 25 pounds
Strong analytical problem solving and strategic thinking skills
Excellent interpersonal skills
Basic computer skills and proficient in Microsoft Office
Moderate to advanced computer skills required
Ability to work at a moderate speed
Must possess strong telephone communication skills and etiquette
Detail oriented, excellent organizational skills
We Offer
PharmScript offers a robust suite of benefits to support employees and their families.
Health and Wellness Benefits
Medical, Prescription Drug, Dental, and Vision coverage for you and your eligible dependents
Maternity care program and infertility services
Tax-favored Health Savings Accounts, Healthcare, and Dependent Care Flexible Spending Accounts.
EAP Assistance Program with 24/7 access to free counseling, legal guidance, and financial resources
Paid Time Off and Holidays
15 PTO days annually and 6 paid/floating holidays
Retirement Planning
401(k) retirement planning with company match
Commuter Benefits
Transit/Parking Spending Account
Voluntary Benefits
Employee Life and Accidental Death & Dismemberment, Short/Long-term Disability, Critical Illness, Accident, and Hospital Indemnity plans are available for you and eligible dependents,
Other Perks and Benefits
Legal & Identity Theft Protection Programs
Employee Discounts: Instant savings on hundreds of products and services
Pet Insurance
Employee Support Program to eligible employees in times of urgent need
Pay Transparency
To reinforce our commitment to fair and equal pay transparency, PharmScripts compensation is based on multiple non-discriminatory, individualized factors including but not limited to experience, job-related knowledge, education, skills, and office/market location.
EEO Statement
PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law.
EO/Minorities/Females/Disabled/Veterans
Min
USD $18.00/Hr.
Max
USD $20.00/Hr.
Apply Now
PharmScript is one of the nations leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most.
Job Summary
Were looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department. As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential.
Responsibilities
Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner
Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior
Prioritize your work activities daily
Timely response to all customer inquiries, both inbound and outbound prior
Responsible for working with nursing facilities/customer service representative to review charges related insurance
Qualifications
High school degree
Must possess or be willing to apply for NJ Pharmacy Technician license
Previous experience working with Long-term care facilities preferred
Able to work independently as well as in a diverse, team environment
Reliable, able to work under pressure and meet deadlines
Excellent communication skills, professional demeanor
Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances
Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items
Physical Demands and Work Environment
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
May be necessary to work extended hours as needed
May lift and/or move up to 25 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Knowledge, Skills, and Abilities
Able to identify and resolve issues quickly and efficiently
Excellent communication, problem solving and organizational skills
Comfortable working independently as well as in a diverse, team environment
Able to work under pressure and meet deadlines
Strong customer service skills
Ability to lift and/or move up to 25 pounds
Strong analytical problem solving and strategic thinking skills
Excellent interpersonal skills
Basic computer skills and proficient in Microsoft Office
Moderate to advanced computer skills required
Ability to work at a moderate speed
Must possess strong telephone communication skills and etiquette
Detail oriented, excellent organizational skills
We Offer
PharmScript offers a robust suite of benefits to support employees and their families.
Health and Wellness Benefits
Medical, Prescription Drug, Dental, and Vision coverage for you and your eligible dependents
Maternity care program and infertility services
Tax-favored Health Savings Accounts, Healthcare, and Dependent Care Flexible Spending Accounts.
EAP Assistance Program with 24/7 access to free counseling, legal guidance, and financial resources
Paid Time Off and Holidays
15 PTO days annually and 6 paid/floating holidays
Retirement Planning
401(k) retirement planning with company match
Commuter Benefits
Transit/Parking Spending Account
Voluntary Benefits
Employee Life and Accidental Death & Dismemberment, Short/Long-term Disability, Critical Illness, Accident, and Hospital Indemnity plans are available for you and eligible dependents,
Other Perks and Benefits
Legal & Identity Theft Protection Programs
Employee Discounts: Instant savings on hundreds of products and services
Pet Insurance
Employee Support Program to eligible employees in times of urgent need
Pay Transparency
To reinforce our commitment to fair and equal pay transparency, PharmScripts compensation is based on multiple non-discriminatory, individualized factors including but not limited to experience, job-related knowledge, education, skills, and office/market location.
EEO Statement
PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law.
EO/Minorities/Females/Disabled/Veterans
Min
USD $18.00/Hr.
Max
USD $20.00/Hr.
Apply Now