Pharmacy Claims Specialist
About The Position
This role is responsible for the adjudication of daily unit dose and non-unit dose claims, contacting insurance for proper overrides, and managing new admits for assigned homes. The specialist will also prepare welcome packets for new patients/families, ensure documents and emails are processed timely, and obtain authorizations for non-covered medications. Additionally, the role involves managing monthly adjudication of cycle batches, working customer notes, adding specific patient types to systems, and assisting with rebilling and open billing batches. Communication of issues preventing timely batch posting is also a key responsibility, along with assisting with other assigned projects.
Requirements
- Experience in pharmacy claims processing
- Familiarity with unit dose and non-unit dose claims
- Ability to contact insurance providers for overrides
- Experience with new patient admissions processing
- Proficiency in auditing patient admission data
- Skill in preparing patient welcome packets
- Experience working with ECM Billing folders
- Ability to manage billing email correspondence
- Experience obtaining authorizations for medications
- Proficiency in monthly adjudication of cycle and reject batches
- Experience working customer notes
- Familiarity with adding Hospice and VA med lists
- Experience with Cubex temp patients for LTC
- Ability to work BI-Call batches
- Experience assisting with rebilling and open billing batches
- Strong communication skills regarding billing issues
Nice To Haves
- Experience as a Receptionist
- Experience with printing and mailing documents
Responsibilities
- Responsible for adjudication of daily unit dose and non-unit dose claims
- Contacting insurance for proper overrides
- New Admits for assigned homes (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
- Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.
- Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
- Prepare Welcome Packet to all new PVT patients/families
- Ensure documents in ECM Billing folders are worked timely
- Ensure Emails to Billing Email are worked timely
- Authorizations – gaining approval from facilities and families on non-covered meds or medication requiring authorization
- Manage Monthly Adjudication of Cycle Batches/ Unit Dose Reject Batches
- Working assigned Customer Notes in a timely manner
- Adding Hospice and VA Med list
- Cubex Temp patients for LTC
- Work any BI-Call batches for homes
- Assist billing with rebilling/working open billing batches
- Communicate issues in preventing batches from being posted in a timely manner
- Assist with other projects as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
