What are the responsibilities and job description for the Insurance Claims Medical position at Res Care, Inc.?
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!
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.
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
- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to PharMerica and their customers.
- 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.
- Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
- Contact providers and/or customers as necessary to obtain additional information needed for claims processing.
- Monitor and resolve at risk revenue associated with payer set up, billing, rebilling and reversal processes.
- Work as a team to identify, document, communicate and resolve payer/billing trends and issues
- Timely complete, communicate and submit necessary payer paperwork including but not limited to benefit eligibility assessment, claim to old overrides and manual claim forms.
- When necessary, will rebill claims electronically in accordance with NCPDP standards, online through payer specific websites, manually through Universal Claim Forms, or through other approved methods for favorable resolution of denied claims
- Review and work convert billing exception reports to ensure claims are billed to accurate financial plans.
- Complete billing transactions for non-standard order entry situations as required.
- Consistently meets productivity metrics and performance standards
- Prepares and maintains reports and records for processing.
- Performs other related duties 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.
Qualifications
- Education/Learning Experience
- Required: High School graduate, GED or equivalent experience
- Desired: Associates degree, 4 year college or technical degree
- Work Experience
- Required: 1 year insurance billing experience
- Desired: Third Party Billing or collections/billing experience in the healthcare industry
- Desired: General understanding of billing requirements for Medicare Part D, Medicaid, and Commercial billing
- Desired: Understanding of revenue cycle functions within pharmacy practice or equivalent setting
- Skills/Knowledge
- Required: Strong Analytical Skills, Excellent time management and attention to details
- Required: Working knowledge in MS Office Products (Excel, Word) and basic computer knowledge
- Required: Comfortable making phone calls and interacting with internal/external entities
- Desired: AS400, Frameworks or QS1, Computer Systems Experience
- Licenses/Certifications
- Required: N/A
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, Twitter, and LinkedIn.