PropacPayless - Vancouver - 3rd Party Claims Processing Specialist I (CPhT) $500 Sign On Bonus:
PharMerica

36352-en_US
PharMerica
Vancouver Washington
Pharmacy
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Description

PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.

 

 

PharMerica in Vancouver, WA is hiring for a full time 3rd Party Claims Processing Specialist I with a Pharmacy Technician license.

 

Ensure payer rejected claims are paid with critical deadlines prior to medication leaving the pharmacy while adhering to compliance standards in a high volume, fast paced environment. The position will be trained in third party adjudication, calling insurance companies, assisting Pharmacists in getting orders changed to covered alternatives, answering questions regarding medication coverage and authorizations, and initiating Prior Authorizations. 

 

Essential Functions:

  • Maintain current and good standing with Washington Board of Pharmacy as a Pharmacy Technician or Pharmacy Assistant.
  • 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.
  • Works with Pharmacists to determine claims are ran accurately, and provide alternatives if appropriate at the direction of a Pharmacist.
  • Contact providers and/or customers as necessary to obtain additional information.
  • Maintains communications with facilities in regards to non-covered items.
  • Communicates with doctor’s regarding physician orders for medications.
  • Work as a team to identify, document, communicate and resolve payer/billing trends and issues
  • Works directly with insurance companies and processors to get claims paid in a timely manner.
  • Timely complete, communicate and submit necessary payer paperwork including but not limited to prior authorizations forms and manual billing.
  • Answers telephone inquiries regarding prior authorizations.
  • Review and work convert billing exception reports to ensure claims are billed to accurate financial plans.
  • Complete billing transactions for non-standard order entry situations as required.
  • Support training needs.
  • Meets deadlines and effectively communicates within the team to meet deadlines.
  • 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.

 

Minimum Qualifications:

  • High School Diploma or GED
  • Associate or Bachelor degree desired
  • WA Pharmacy Technician license required
  • Up to one year of related experience preferred
  • Pharmacy Technician experience desired
  • Ability to retain a large amount of information and apply that knowledge to related situations 
  • Ability to work in a fast paced environment
  • Basic math aptitude  
  • Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters
  • Must be available to work:  12:30 to 9:00 pm Monday through Friday

 

EOE/M/F/D/V

Accelerate Your Career with PharMerica!

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