Pharmacy Claims Specialist - Full Time

Overview

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

Responsible for long-term care pharmacy third party billing functions as assigned by the Billing Manager. Works alongside the pharmacy operations team to ensure timely submission and resolution of prescription claims.

Responsibilities

A day in the life of a Pharmacy Claims Specialist at Hackensack Meridian Health includes:

1. Submit daily prescription batches for payment by third party payers.
2. Research and establish patient eligibility coverage with prescription insurance providers.
3. Maintain and update patient billing and prescription insurance information.
4. Troubleshoot rejected insurance claims resulting in payments.
5. Interact with the prescription insurance companies on a daily basis regarding overrides, rejections, and insurance updates.
6. Follow-up on and resolve pending billing issues.
7. Process daily rejected prescription claims.
8. Research and submit unit-dose billing rejected claims on a weekly basis.
9. Submit, track, and follow-up on prior authorizations.
10. Assist with Customer Pre-Admission Price Quotes.
11. Check Medicaid eligibility on Medicaid Pending LTC residents and rebill claims
12. Other duties as assigned.

Qualifications

Education, Knowledge, Skills and Abilities Required:

1. High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
2. Minimum of one (1) year of experience as a pharmacy tech in a retail/long-term care pharmacy setting.
3. Excellent customer service and phone skills.

Education, Knowledge, Skills and Abilities Preferred:

1. Associate's degree.
2. Long-term care billing department experience.
3. Framework LTC experience.
4. GSuite (Docs, Sheets, and Gmail).

Licenses and Certifications Required:

1. Pharmacy Technician License.

If you feel the above description speaks directly to your strengths and capabilities, then please apply today!

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.