RCO-Advanced Claims Review Specialist

Overview

PharmScript is one of the nation’s leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most.

Job Summary

We’re looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department. As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential.

Responsibilities
• Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner
• Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior
• Prioritize your work activities daily
• Timely response to all customer inquiries, both inbound and outbound prior
• Responsible for working with nursing facilities/customer service representative to review charges related insurance

Qualifications
• High school degree
• Must possess or be willing to apply for NJ Pharmacy Technician license
• Previous experience working with Long-term care facilities preferred
• Able to work independently as well as in a diverse, team environment
• Reliable, able to work under pressure and meet deadlines
• Excellent communication skills, professional demeanor
• Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
• Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances
• Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items

Physical Demands and Work Environment

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
• May be necessary to work extended hours as needed
• May lift and/or move up to 25 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

Knowledge, Skills, and Abilities
• Able to identify and resolve issues quickly and efficiently
• Excellent communication, problem solving and organizational skills
• Comfortable working independently as well as in a diverse, team environment
• Able to work under pressure and meet deadlines
• Strong customer service skills
• Ability to lift and/or move up to 25 pounds
• Strong analytical problem solving and strategic thinking skills
• Excellent interpersonal skills
• Basic computer skills and proficient in Microsoft Office
• Moderate to advanced computer skills required
• Ability to work at a moderate speed
• Must possess strong telephone communication skills and etiquette
• Detail oriented, excellent organizational skills

We Offer

PharmScript offers a robust suite of benefits to support employees and their families.

Health and Wellness Benefits
• Medical, Prescription Drug, Dental, and Vision coverage for you and your eligible dependents
• Maternity care program and infertility services
• Tax-favored Health Savings Accounts, Healthcare, and Dependent Care Flexible Spending Accounts.
• EAP Assistance Program with 24/7 access to free counseling, legal guidance, and financial resources

Paid Time Off and Holidays
• 15 PTO days annually and 6 paid/floating holidays

Retirement Planning
• 401(k) retirement planning with company match

Commuter Benefits
• Transit/Parking Spending Account

Voluntary Benefits
• Employee Life and Accidental Death & Dismemberment, Short/Long-term Disability, Critical Illness, Accident, and Hospital Indemnity plans are available for you and eligible dependents,

Other Perks and Benefits
• Legal & Identity Theft Protection Programs
• Employee Discounts: Instant savings on hundreds of products and services
• Pet Insurance
• Employee Support Program to eligible employees in times of urgent need

Pay Transparency

To reinforce our commitment to fair and equal pay transparency, PharmScript’s compensation is based on multiple non-discriminatory, individualized factors including but not limited to experience, job-related knowledge, education, skills, and office/market location.

EEO Statement

PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law.

EO/Minorities/Females/Disabled/Veterans

Min

USD $18.00/Hr.
Max

USD $20.00/Hr.

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