Posted in General Business 30+ days ago.
This role, reporting to the ProviderPay Operations Supervisor, is responsible for the daily management of claims data and coordination for current customers. This role manages paper-based remittance advice, ensuring qualified claims are identified and moved forward in the reconciliation process. Proactively obtains needed remittance detail from appropriate third-party payers to include in reconciliation process. Conducts routine audits and process flow reviews to ensure accuracy and efficiency. Collaborates with internal team members to research and resolve reported issues for current customers.
Minimum Job Qualifications (Knowledge, Skills, & Abilities):
Requires 3+ years of related experience
Education/Training: Associate/ Bachelor’s degree preferred.
Specialized Knowledge/Skills: Managed care experience. Pharmacy operations / claims adjudication knowledge or experience. Pharmacy reimbursement / reconciliation knowledge or experience.
Working Conditions: Environment (Office, warehouse, etc.) – General Office
Physical Requirements (Lifting, standing, etc.) – General office