3rd Party Claims Specialist

Company: A-Line Staffing Solutions
Location: Taunton
Posted on: May 10, 2022

Job Description:

A-Line Staffing Solutions is looking to hire a 3rd Party Claims Specialist for a major healthcare company in Taunton, MA! If you would like to apply for this position please contact Ryan Linska 586-473-6099 rlinska@alinestaffing.com Job Details: Shift: Monday through Friday 8am to 5pm Details: 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. If you would like to apply for this position please contact Ryan Linska 586-473-6099 rlinska@alinestaffing.comJob Requirements: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 Competencies Required: Communication, Problem Solving, Detail Oriented and Teamwork, Customer Service, and Accuracy. Required: Strong organization skills, self-starter, and confidence

Keywords: A-Line Staffing Solutions, Taunton , 3rd Party Claims Specialist, Other , Taunton, Massachusetts