Pharmacy Claims Specialist

Job Address:

Pharmacy Claims Specialist
Responsibilities: 

Responsible for adjudication of daily unit dose and non-unit dose claims

• Contacting insurance for proper overrides 

New Admits for assigned homes (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable) 

• Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.    

• Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable) 

• Welcome Packets – prepare Welcome Packet to all new PVT patients/families

• Receptionist will mail and Print the packet

Ensure documents in ECM Billing folders are worked timely

Ensure Emails to Billing Email are worked timely 

Authorizations – gaining approval from facilities and families on non-covered meds or medication requiring authorization

Manage Monthly Adjudication of Cycle Batches/ Unit Dose Reject Batches

Working assigned Customer Notes in a timely manner

Adding Hospice and VA Med list 

Cubex Temp patients for LTC 

Work any BI-Call batches for homes

Assist billing with rebilling/working open billing batches

• Communicate issues in preventing batches from being posted in a timely manner

Assist with other projects as assigned