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Pharmacy Biller

Company: Pharmaceutical Strategies
Location: Brockton
Posted on: May 11, 2018

Job Description:

Job DescriptionWe are currently hiring a Pharmacy Biller in the Brockton, M.A area !

  • Research and process denied pharmacy claims working with insurance companies, Medicaid, pharmacy benefit managers, facilities and pharmacies in a high volume, fast paced environment
  • Ensures approval of claims through performing reverses as necessary on edits discovered during the filling process (wrong NDC Number, refills to soon, brand v generic, reimbursement discrepancies, etc.) by resolving discrepancies with Purchasing Associates, pharmacists, DON or Nurse.
  • Identifies and proactively resolves denied claims by working with insurance companies, Medicaid, nursing facilities and family members to ensure minimal loss of non-reimbursed inventory and meeting critical deadlines.
  • Follow-up with Directors of Nursing and Nursing Staff to communicate unresolved denials or status changes allowing alternate courses of therapy to be prescribed or to resolve payor issues.
  • Completes the necessary authorization forms (Certification of Medical Necessity, Prior Authorization Forms, etc.) to ensure appeals are executed in with physicians, DON’s and Claims Processors in a timely manner.
  • Monitor and resolve at risk revenue associated with the reversal process.
  • Review and work convert report generated from Payor source changes to ensure appropriate claims billed to accurate plans.
  • Complete billing transactions for non standard order entry situations, as needed.
  • Performs other tasks as assigned. This is an Urgent Need! - For immediate consideration please submit your resume and call 866 – 352 - 3337Company DescriptionPharmaceutical Strategies is a recruiting firm that specializes in the placement of professionals in pharmacies, hospitals, healthcare organizations and life sciences companies. We offer contract and direct hire services and work all over the U.S. Over the last 10 years, we have become a premier provider of talent and in 2014, we were awarded Inavero's "Best of Staffing for Client Satisfaction" Award.

    Keywords: Pharmaceutical Strategies, Brockton, Pharmacy Biller, Healthcare, Brockton, Massachusetts

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