- 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.
- Pharmacy technician experience,.
- Long term care experience a plus.
- Experience with Adjudication preferred
-
Claim Specialist WC
1 week ago
HEMIC Honolulu, United StatesJoin us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our business is founded on caring fo ...
-
Claims Operation Specialist
1 week ago
Hawaii Medical Service Association Honolulu, United StatesJob SummaryPay Range: $57,629 - $88,159Note: Individuals typically begin between the minimum to middle of the pay rangeThe Claims Operation Specialist tracks, analyzes, and resolves claims and claims related system issues while collaborating with our vendor to streamline operatio ...
-
Claim Specialist WC
2 weeks ago
HEMIC Honolulu, United StatesJob Description · Job Description · Join us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: · People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplac ...
-
Claim Specialist WC
2 days ago
HEMIC Honolulu, United StatesJob Description · Job DescriptionJoin us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: · People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our ...
-
Medical Claim Specialist
2 days ago
HEMIC Honolulu, United StatesJob Description · Job DescriptionJoin us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 6 Years in a Row · As a HEMIC employee, you will get: · People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our ...
-
Surety Claims Specialist
1 week ago
Sedgwick Honolulu, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Claims Operation Specialist
3 days ago
HMSA Honolulu, United StatesCollect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation M ...
-
Claims Operation Specialist
1 week ago
HMSA Honolulu, United StatesCollect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation M ...
-
Entry-Level Claims Specialist
2 weeks ago
ALTRES Staffing Honolulu, United States Full timeEntry-Level Claims Specialist (Workers' Comp Work for a local insurance company, voted one of Hawaii's Best Places to Work · As the Workers' Comp Claims Specialist, you will manage workers' compensation claims for medical only, lost time, and disfigurement. A current Hawaii worke ...
-
ESIS Claims Specialist, WC
1 week ago
Chubb Honolulu, United StatesJob Description · ESIS, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our cl ...
-
ESIS Claims Specialist, WC
2 days ago
Chubb Honolulu, United StatesESIS, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk ...
-
ESIS Claims Specialist, WC
1 week ago
Chubb Honolulu, United StatesJob Description · ESIS, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our cl ...
-
Credentialing & Medical Billing Specialist
1 week ago
Aishling Obstetrics & Gynecology SC/Fox Valley Vein Centers Sandwich, United States**Benefits**: · - 401(k) · - Competitive salary · - Employee discounts · - Flexible schedule · - Paid time off · Aishling Obstetrics & Gynecology is looking for a dynamic and motivated full-time Credentialing Specialist with Medical Billing experience. In Essential functions of t ...
-
Business Services Support Specialist
1 week ago
The Queen's Health Systems, Inc. Honolulu, United States Full timeUnder the general direction of the Business Services Manager, provides support services to the Medicare Certified Division staff. Performs a variety of duties including verification of health insurance claims numbers and benefits coverages; process a Support Specialist, Business ...
-
Healthcare Specialist
1 week ago
TEKsystems Honolulu, United StatesTEKsystems in Hawaii is looking for a Healthcare Specialist to support one of the local healthcare companies in Hawaii This role is primarily remote but requires some occasional travel 1-2 times a week on Oahu or Kauai. Travel expenses will be paid for. If you are interested, ple ...
-
ISLAND HEALTHCARE SOLUTIONS LLC Honolulu, United StatesJob Description · Job DescriptionBenefits:Competitive salary · Dental insurance · Flexible schedule · Health insurance · Paid time off · Vision insurance · Island Healthcare Solutions is a comprehensive billing, coding and consulting service focused on hospital-based physician an ...
-
Branch Support Specialist
2 days ago
Allied Universal® Honolulu, United StatesJob Description · Job DescriptionOverviewAllied Universal, North America's leading security and facility services company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workplace, you will be part of a team that fue ...
-
provider relations representative
2 weeks ago
TEKsystems Honolulu, HI , USA, United StatesALOHA · Seeking a Provider Relations Representative in Honolulu, Hawaii. · Full-Time opportunity, · Monday-Friday, 7:30 am- 4:30 pm. · Work from home remotely + On-site Provider Office visits on Oahu · Description: · Manages individual and group provider relationships in network ...
-
Provider Relations Representative
1 week ago
TEKsystems Honolulu, United StatesALOHA Seeking a 'Provider Relations Representative' in Honolulu, Hawaii. Full-Time opportunity, Monday-Friday, 7:30 am- 4:30 pm. Work from home remotely On-site Provider Office visits on Oahu Description: Manages individual and group provider relationships in network for provider ...
-
Provider Relations Representative
1 week ago
TEKsystems Honolulu, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or City and state must be separated by a comma followed by a space (e.g., Houston, TX ) · ALOHA · Seeking a "Provider Relations Representative" in Honolulu, Hawaii. · Full-Time ...
Pharmacy Technician- Claims Specialist- Honolulu, HI - RPh on the Go
Description
Job Description
Job DescriptionMinimum 1+ years pharmacy experience required.RPh on the Go is looking for a pharmacy technician to add to our claims specialist team in Aiea, HI. This is an 8-week temp to perm positionand were interviewing to start ASAP. Technician trainees are welcome to apply
Shifts:
Monday - Saturday 9am- 5:30pm.
(If they work a Saturday, will get a week day off).
Essential Duties:
Qualifications:
How to Apply:
Interested candidates are invited to send an updated resume to or call at for immediateconsideration.
