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:Requir...Pharmacy Technician, Claims Specialist, Healthcare, Business Services, Billing
BrightSpring Health Services
06/26/2024
Taunton,MA