Job Overview
We are seeking a dedicated and detail-oriented Pharmacy Claims Specialist to join our team. The ideal candidate will possess a strong understanding of pharmacy claims, with emphasis on compound vs. non-compound claims adjudication & troubleshooting.
Responsibilities
- Process pharmacy compound claims
- Audit patient charts to ensure pharmacy compound records align with billed pharmacy claims.
- Troubleshoot rejected pharmacy claims
- Serve as gatekeeper of pharmacy claims ensuring correct processing based on payer guidelines.
- Process pharmacy prior authorization requests in a timely manner
- Assist benefits verification team test claims processing, eligibility checks, etc.
- Assist patient collections team in collecting patient responsibilities including Rx Copays.
- Ensure compliance with pharmacy benefit plans
- Complete pharmacy benefit manager audit requests in a timely manner.
Join our team as a Benefit Specialist where you can make a meaningful impact on the lives of patients.
Job Types: Full-time, Part-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
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