3rd Party Claims Specialist
Company: A-Line Staffing Solutions
Location: Taunton
Posted on: May 10, 2022
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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
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here to apply!
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