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    claims Specialist - Honolulu, United States - ResCare

    ResCare
    ResCare Honolulu, United States

    2 weeks ago

    Default job background
    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

    Schedule:
    Monday-Saturday; with a day off during the weekplease note this role is ON-SITE in Honolulu, HI

    Pay Rate:
    $22/HR

    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 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 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 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.
    Salary Range
    USD $19.00 / Hour

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