Job Information
ResCare Premier Inc. CLAIMS SPECIALIST in Vancouver, Washington
Requisition: 2024-135603 CLAIMS SPECIALIST Job Locations US-WA-VANCOUVER ID 2024-135603 Line of Business PharMerica Position Type Full-Time Pay Min USD $22.00/Hr. Pay Max USD $22.00/Hr. 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! We are seeking individuals who have experience in Pharmacy who are ready to make a change. This is an excellent opportunity for Pharmacy Technicians to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing. Remote position. Applicants can reside anywhere with the continental USA. Schedule: Monday - Friday 12:30-9pm Pacific time 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 * Training inclusive auditing for accuracy of claim processing and working with team on training documents * Third Party Claims processing and payer subject matter expert * Provide support to 3rd Party Claims Specialist I answering operational questions * Support supervisory team by monitoring 3rd party at risk revenue * Support supervisory team with managing work queue * Review/resolve elevated issues * Complete quality assessment review of staff transactions * Work as a team to identify, document, communicate and resolve payer/billing trends and issues * Provide feedback to supervisor on staff performance * Prepares and maintains reports and records for processing. * Back up support for all operational functions of team including but not limited to 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. * Review and code revenue adjustments and/or write offs for management review and approval * Establish payer relationships to support operations * Performs other tasks 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. * To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Qualifications Education/Learning Experience * Required: High School Diploma or GED * Desired: Associate's or Bachelor's Degree Work Experience * Required: Custom