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3rd Party Claims Specialist

Company: A-Line Staffing Solutions
Location: Taunton
Posted on: September 20, 2022

Job Description:

NOW HIRING! A-Line Staffing is seeking those with Health/Medical Insurance Claim experience, Benefit Verification or Prior Authorization experience for a 3rd Party Claims Specialist role with a large healthcare company ON SITE in their office in Taunton, MA. APPLY NOW for immediate consideration!Pay: $18Shift: Monday through Friday 8am to 5pmDetails: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 issuesTimely 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 claimsReview 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 standardsPrepares and maintains reports and records for processing.Performs other related duties as assignedConducts 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.Education/Learning ExperienceRequired: High School graduate, GED or equivalent experienceDesired: Associates degree, 4 year college or technical degreeWork ExperienceRequired: 1 year insurance billing experienceDesired: Third Party Billing or collections/billing experience in the healthcare industryDesired: General understanding of billing requirements for Medicare Part D, Medicaid, and Commercial billingDesired: Understanding of revenue cycle functions within pharmacy practice or equivalent settingSkills/KnowledgeRequired: Strong Analytical Skills, Excellent time management and attention to detailsRequired: Working knowledge in MS Office Products (Excel, Word) and basic computer knowledgeRequired: Comfortable making phone calls and interacting with internal/external entitiesDesired: AS400, Frameworks or QS1, Computer Systems ExperienceCompetenciesRequired: Communication, Problem Solving, Detail Oriented and Teamwork, Customer Service, and Accuracy.Required: Strong organization skills, self-starter, and confidenceAPPLY NOW with Dan Lupo at A-Line Staffing! 586-323-4178 // DLupo@Alinestaffing.com

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

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