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3rd Party Claims Specialist II

Date: Jul 12, 2018

Location: Brockton, MA, US

Company: PharMerica

PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.

 

 

Essential Functions:

  • Training inclusive auditing for accuracy of claim processing and working with team on training documents
  • Third Party Claims processing and payer subject matter expert
  • Provide support to 3rd Party Claims Specialist I answering operational questions
  • Support supervisory team by monitoring 3rd party at risk revenue including but not limited to INER, Rejects, C01 errors, Reversals, MCLM
  • Support supervisory team with managing work queue
  • Review/resolve elevated issues
  • Complete quality assessment review of staff transactions
  • Work as a team to identify, document, communicate and resolve payer/billing trends and issues
  • Provide feedback to supervisor on staff performance
  • Prepares and maintains reports and records for processing.
  • Back up support for all operational functions of team including but not limited to research, analyze and appropriately resolve 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.
  • Review and code revenue adjustments and/or write offs for management review and approval
  • Establish payer relationships to support operations
  • Performs other tasks as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.  Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Education/Learning Experience:

  • Required:  High School Diploma or GED
  • Desired:  Associate’s or Bachelor’s Degree

Work Experience:

  • Required: Customer Service.  Up to 2 years of related experience
  • Desired: Pharmacy Technician experience.   Leadership

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.   AS400 Database.

Licenses/Certifications:

  • Desired:   Pharmacy technician

Behavior Competencies:

  • Required:  Customer Service.  Oral and written communication.   Detail Orientation.  Results Orientation.  Teamwork. Adaptability to an ever changing environment.   Analytical and problem solving.  
  • Desired:  Leadership

 

EOE M/F/D/V

Accelerate Your Career with PharMerica!


Nearest Major Market: Brockton
Nearest Secondary Market: Boston