Pharmacy Claims Medicare Part B Aging Specialist, CPhT

Overview

Research, collect, and resolve unpaid pharmacy Medicare Part B claims. Prevent future unpaid claims, research and apply cash exceptions, and identify and issue refunds due to patients, Medicare contractors, and supplemental insurers. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.

• Identify and research outstanding/aged pharmacy claims using resources including, but not limited to, Spectrum, paper remittances, KASH Third Party Web tools, agency websites, automated phone systems, live phone calls to agencies, OmniSYS resources, and store systems
• Proactively report on and resolve issues that could impact the aging report
• Identify and research payments not matched to claims
• Respond to demand letters from Medicare contractors and supplemental insurers
• Research/respond to agency/store/division inquiries regarding outstanding claims
• Research/respond/resolve refunds due to the patient as a result of incorrect co-payments on Medicare claims
• Must be able to perform the essential job functions of this position with or without reasonable accommodation

Minimum

• Nationally Certified Pharmacy Technician
• Self-starting and able to perform job responsibilities with minimal supervision
• Physical ability to access all necessary files
• Must be highly organized and detail oriented and able to function effectively in a multi-task environment
• Strong analytical skills
• Must be able to use discretion and maintain confidential information
• Ability to work well with others
• Good written and verbal communication and customer service skills
• Working knowledge of Microsoft Office, including Excel

• Basic insurance knowledge and Medicare/ Medicaid knowledge
• General knowledge of medical billing and coding
• Knowledge of third-party operations and accounts receivable
• Knowledge of Pharmacy store systems (Easy Fill PRN)