Job Information
BrightSpring Health Services 3RD PARTY CLAIMS SPECIALIST I in TAUNTON, Massachusetts
Our Company
Overview
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
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 www.pharmerica.com. Follow us on Facebook (https://www.facebook.com/PharMericaCorp/) , Twitter (https://twitter.com/PharMericaCorp/) , andLinkedIn (https://www.linkedin.com/company/pharmerica/) .
Additional Job Information
Must be available to work Monday to Friday from 8:30 - 5:00 pm.
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BrightSpring Health Services, and our family of brands, provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact the BrightSpring Disabilities Support Team at 1-833-773-7240 orcontact us (https://www.brightspringhealth.com/application-assistance/) for assistance.
Equal Opportunity Employment Posters (https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm)
Clickhere (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.
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Job LocationsUS-MA-TAUNTON
ID2020-13422
Position TypeFull-Time
Line of BusinessPharMerica