BrightSpring Health Services

3RD PARTY CLAIMS RECON, ASSOCIATE I

Job Locations US-MA-TAUNTON
ID
2021-20017
Position Type
Full-Time
Line of Business
PharMerica

Our Company

PharMerica Logo_1250x667

Overview

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

Responsibilities


  • Conducts auditing for accuracy of claim processing and works with team on training documents

  • Third party claims processing and payer subject matter expert

  • Provides support answering operational questions

  • Supports supervisory team by monitoring third-party, at-risk revenue; including but not limited to INER, rejects, C01 errors, reversals, & MCLM

  • Supports supervisory team with managing work queue

  • Reviews/resolves elevated issues

  • Completes quality assessment review of staff transactions

  • Works as a team to identify, document, communicate and resolve payer/billing trends and issues

  • Provides feedback to supervisor on staff performance

  • Prepares and maintains reports and records for processing

  • Provides back-up support for all operational functions of team including but not limited to research, analysis and resolution of rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement while adhering to critical deadlines.

  • Reviews and codes revenue adjustments and/or write-offs for management review and approval

  • Establishes payer relationships to support operations

  • Performs other duties as assigned

Qualifications

Education/Learning Experience:



  • Required: High School Diploma or GED

  • Desired: Associate’s or Bachelor’s Degree


Work Experience:



  • Required: Customer Service. Up to 2 years of related experience

  • Desired: Pharmacy Technician experience and leadership skills


Skills/Knowledge:



  • Required: 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. Microsoft Office Suite

  • Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters. AS400 Database


Licenses/Certifications:



  • Desired: Pharmacy technician


Behavior Competencies:



  • Required: Customer service, oral and written communication, detail orientation, results driven, team oriented, adaptable, analytical and strong problem solving ability

  • Desired: Leadership

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication.  PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.  PharMerica is one of the nation's largest pharmacy companies.  PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.  For more information about PharMerica, please visit www.pharmerica.com.  Follow us on FacebookTwitter, and LinkedIn.

Additional Job Information

Must be available to work hours between 7 am to 5:30 pm Monday to Friday with flexible start times.

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