medical insurance claims specialist

State of Arizona

<div><div><div><div><div><ul><li>541302
</li></ul></div><div><ul><li>PHOENIX
</li></ul></div><div><ul><li>INDUSTRIAL COMMISSION
</li></ul></div><div><ul><li>Full-time
</li></ul></div><div><ul><li>Closing at: Jun 16 2026 - 23:55 MST
</li></ul></div></div><p></p><div><div><h1 class="jobSectionHeader"><b>INDUSTRIAL COMMISSION</b></h1>
<h2 class="jobSectionHeader"><b><i>Are you ready to work for an exceptional state agency that works to protect the life, health, safety, and welfare of the employees in the State of Arizona? Apply with us! The Industrial Commission of Arizona (ICA) is committed to the highest standards of compliance, demonstrating leadership in all areas, and teaching and working with employers and employees to make them successful. A thriving workforce in Arizona is what we strive for and work towards each day.</i></b></h2>
</div><h3 class="jobSectionHeader"><b>W/C INSURANCE CLAIMS SPECIALIST 2</b></h3>
<div>Job Location:
</div><div><h4 class="jobSectionHeader"><b>Address: Claims Division/Compliance Section</b><br>
<b>800 W. Washington Street, Phoenix, AZ 85007</b></h4>
</div><div>Posting Details:
</div><div><h4 class="jobSectionHeader"><b>Salary: $17.05 - $17.60</b><br>
<b>
</b></h4><h4 class="jobSectionHeader"><b>Grade: 17</b><br>
<b>
</b></h4><h4 class="jobSectionHeader"><b>Closing Date: June 16, 2026</b></h4>
</div><div>Job Summary:
</div><div><p>This position is responsible to audit incoming claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws.</p>
<p><i>
This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.</i></p>
<p><i>
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State&rsquo;s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.</i></p>
</div>
<div>Job Duties:
</div><div><div>Essential Duties and Responsibilities include but are not limited to:<br>
<ul><li>This position will critically analyze submitted forms for compliance and issue appropriate awards when indicated.</li><li>Audit insurance carriers, self-insured employers and third-party administrators adjusting workers&rsquo; compensation claims.
</li><li>Reviews all notices, attached medical and/or documentation to verify it supports current change of status and/or calculation of wage and awards. After analysis, specialist will issue correct corresponding award, notification, or document.
</li><li>Answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and the general public.
</li><li>Matches documents lacking information to existing Commission claims files by researching information in Claims database and for creating a new claim file for documents received when there is no existing claim file.</li><li>Provides backup assistance to data entry, error resolution, insurance or combine/delete, as requested and
</li><li>Participates in Arizona Management System (AMS) and daily Huddle board.</li><li>Attends staff meetings, seminars, conferences, training classes.</li></ul></div></div><br>
<div>
Knowledge, Skills &amp; Abilities (KSAs):
</div><div><div>Knowledge in<br>
<ul><li>Basic knowledge or ability to learn of applicable workers compensation claims management laws, statutes, and case laws.
</li><li>Basic Medical terminology.
</li><li>Microsoft Office Suite; Outlook, Word, Excel, Google Office Suite, Gmail, Sheets and Docs</li><li>Basic English</li><li>Basic Mathematics</li><li>The insurance industry claims adjusting standards and practices.
</li></ul><ul><li>Skill in:</li><li>Communicating verbally and in writing to resolve disputes with interested parties.
</li><li>Basic analysis of insurance, medical and legal documents.
</li><li>Reviewing and interpreting Arizona Workers' Compensation laws, rules, procedures, and court decisions</li><li>Critical thinking</li><li>Time Management</li><li>Initiative and attention to detail</li><li>Customer service</li><li>Organizing and planning</li><li>Basic Business process acumen, management skills including workflows and information management.
</li></ul><ul><li>Ability to:</li><li>Interpret medical records to determine physical limitations for injured workers.</li><li>Manage heavy workload with high level of accuracy and production.</li><li>Learn computer systems and applications.</li><li>Work well within a diverse and inclusive office environment.</li><li>Process documents in a timely manner and within established productivity standard.</li><li>Prioritizes work within established time frames.</li><li>Manage time effectively and meet deadlines.</li><li>Adapt to changing circumstances.</li><li>Demonstrate initiative and attention to detail.</li><li>Exercise discretion and judgment.</li><li>Works well under pressure.</li><li>Perform job responsibilities incorporating lean management and principles of the Arizona Management System.</li><li>Produce high quality, nearly error-free output.</li></ul></div></div><br>
<div>
Selective Preference(s):
</div><div><p>The ideal candidate for this position will have:<br>
Claims adjusting license, certification (WCCA, WCCP, CPCU) or designation relating to workers' compensation.</p><br>
</div>
<div>Pre-Employment Requirements:
</div><div><p><i>All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).</i></p>
</div>
<div>Benefits:
</div><div><p>The Arizona Department of Administration offers a comprehensive benefits package to include:
<br>
Sick leave<br>
Vacation with 10 paid holidays per year<br>
Health and dental insurance<br>
Retirement plan<br>
Life insurance and long-term disability insurance<br>
Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance</p><br>
<p><i>
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.</i></p>
<p><i>
For a complete list of benefits provided by The State of Arizona, please visit our </i><i>benefits page</i></p>
</div>
<div>Retirement:
</div><div><p>You will be eligible to participate in the state employee health/disability insurance plan, and you are required to participate in the Arizona State Retirement System (ASRS). ASRS participation may begin immediately or upon your 27th week of employment. Contributions are matched by the employer.</p>
</div>
<div>Contact Us:
</div><div><p>If you have any questions please feel free to call 602-542-5559 or email HR@azica.gov for assistance.</p></div></div></div></div></div>

W/C INSURANCE CLAIMS SPECIALIST 2

Foundation Laboratory

<p>We are seeking Full-Time Billers/Claims Collections Specialist to join our team!</p><p><b>Qualifications:</b></p><ul><li>Minimum two years of experience as a Biller is preferred.</li><li>Laboratory Billing Experience Preferred.</li><li>Correct, appeal and resubmit denied claims or charges.</li><li>Audit patient accounts for proper billing and status.</li><li>Verify, update/edit and approve charges for billing.</li><li>Contact clients or patients regarding account information, diagnosis or verification of payer information.</li><li>Provide customer service to clients or patients in regards to their account balance, statement, pricing and collection of payment.</li><li>Knowledge of ICD-10, NCD/LCD and NCCI guidelines.</li><li>Regular, reliable and predictable attendance required.</li><li>Related experience in a laboratory setting is a plus.</li><li>Bilingual - Spanish is a plus.</li></ul><p><b>Desired Attributes:</b></p><ul><li>Ability to multitask</li><li>Strong interpersonal skills</li><li>Ability to function with the highest level of quality and care</li><li>Strong organizational skills</li></ul><p>Job Type: Full-time</p><p>Pay: $19.00 - $22.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Biller/Claims Specialist

Auto-Owners Insurance

<div><p>A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs.</p><p></p><p><b>
Job Description</b></p><p></p><p><b>
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.</b></p><p></p><p>
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to:</p><ul><li>
Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss.</li><li>
Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage.</li><li>
Follow claims handling procedures and participate in claim negotiations and settlements.</li><li>
Deliver a high level of customer service to our agents, insureds, and others.</li><li>
Devise alternative approaches to provide appropriate service, dependent upon the circumstances.</li><li>
Meet with people involved with claims, sometimes outside of our office environment.</li><li>
Handle investigations by telephone, email, mail, and on-site investigations.</li><li>
Maintain appropriate adjuster&rsquo;s license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute.</li><li>
Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials.</li><li>
Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule.</li><li>
Assist in the evaluation and selection of outside counsel.</li><li>
Maintain punctual attendance according to an assigned work schedule at a Company approved work location.</li></ul><p></p><p><b>
Desired Skills &amp; Experience
</b></p><ul><li>A minimum of three years of insurance claims related experience.</li><li>
The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision.</li><li>
The ability to effectively understand, interpret and communicate policy language.</li><li>
The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues.</li></ul><p></p><p><b>
Benefits</b></p><p>
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!</p><p></p><p><b>
Equal Employment Opportunity</b></p><p>
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.</p><p></p><ul><li><b>Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.</b></li></ul><p></p><h3 class="jobSectionHeader"><b>
#LI-DNI</b></h3></div>

Bodily Injury Claims Specialist

RCM Centric Inc

<p>Our office is looking for a skilled and committed <b>Medical Billing A/R Specialist</b> to join our team. As the Medical Billing A/R Specialist, you will be responsible for analyzing data, evaluating information, and making sound decisions. Your daily tasks will include managing billing software, appealing denied claims, following up on insurance claims, taking action, reviewing denials, reviewing rejections, and tracking late payments. To excel in this role, it is essential to have a thorough understanding of billing software and medical insurance policies.</p><p>Additionally, strong written and verbal communication skills are required as communicating with clients and insurance agents will be a significant aspect of the job. This is an onsite full-time position with competitive compensation and benefits package. If you are a self-motivated individual with a passion for medical billing and a commitment to providing excellent customer service, we encourage you to apply.</p><p><b>Responsibilities:</b></p><ul><li>Preparing and submitting billing data and medical claims to insurance companies.</li><li>Ensuring the patient&rsquo;s medical information is accurate and up to date.</li><li>Preparing bills and invoices, and documenting amounts due for medical procedures and services.</li><li>Collecting and reviewing referrals and pre-authorizations.</li><li>Monitoring and recording late payments.</li><li>Maintain the protocols and documentation of each performed task.</li><li>Following up on missed payments and resolving financial discrepancies.</li><li>Follow-Up on unpaid claims within the Standard Billing Cycle timeframe.</li><li>Communicating with Providers, Insurance Companies and assisting Patients.</li><li>Handling Account Receivables, Denial Management, and Appeal Management.</li><li>Maintaining accurate records of payments received and outstanding balances.</li><li>Working with the Billing Manager to ensure that all payments are processed.</li><li>Examining patient bills for accuracy and requesting any missing information.</li><li>Investigating and appealing denied claims.</li></ul><p><b>Requirements:</b></p><ul><li>Bachelor&rsquo;s degree in business, health care administration, accounting, or a relevant field.</li><li>A minimum of <b>2 years of experience</b> as an A/R Specialist or similar role.</li><li>Solid understanding of billing software and electronic medical records.</li><li>Must have the ability to multitask and manage time effectively.</li><li>Excellent written and verbal communication skills.</li><li>Outstanding problem solving and organizational abilities.</li></ul><p><b>Job Rewards and Benefits:</b></p><ul><li>Paid Leaves</li><li>Saturday and Sunday Off</li><li>Leave Encashment</li><li>Tea &amp; Dinner</li><li>Inflation Bonus</li><li>Attendance Bonus</li><li>Fuel Allowance</li></ul><p>Job Type: Full-time</p><p>Pay: Rs60,000.00 - Rs80,000.00 per month</p><p>Experience:</p><ul><li>A/R Management: 2 years (Preferred)</li><li>Medical Billing: 2 years (Preferred)</li></ul><p>Work Location: In person</p>

Medical Billing A/R Specialist- NIGHT SHIFT

Progress Weight Management

<p><b>Medical Billing Specialist</b></p><p><b>Location:</b> Fargo, ND (In-Person)</p><p><b>Job Type:</b> Full-Time</p><p><b>Pay Range:</b> $18.00&ndash;$25.00 per hour</p><p><b>About the Role</b></p><p>We are seeking a detail-oriented and dependable <b>Medical Billing Specialist</b> to join our growing healthcare team in Fargo, North Dakota. This position plays a critical role in supporting the financial health of our organization by ensuring accurate claim submission, timely reimbursement, and exceptional patient service.</p><p>The ideal candidate has prior medical billing experience, strong problem-solving skills, initiative, and a collaborative work ethic. They are confident in working with insurance claims, billing processes, revenue cycle management, and EHR systems while contributing to a mission-driven healthcare organization.</p><p><b>Key Responsibilities</b></p><p><b>Claims Management &amp; Reimbursement</b></p><ul><li>Prepare, review, and submit accurate medical claims to commercial insurance carriers, Medicare, Medicaid, Tricare, and other third-party payers.</li><li>Audit claims for completeness and accuracy prior to submission.</li><li>Monitor claim status and perform follow-up on unpaid, delayed, denied, or rejected claims.</li><li>Research claim issues and coordinate appeals to maximize reimbursement.</li><li>Document all follow-up activities and claim actions within patient account records.</li></ul><p><b>Insurance Verification &amp; Eligibility</b></p><ul><li>Verify patient insurance eligibility and benefits prior to services.</li><li>Identify authorization and referral requirements when applicable.</li><li>Confirm coverage limitations and patient financial responsibility.</li></ul><p><b>Patient Billing &amp; Customer Service</b></p><ul><li>Generate and distribute patient statements.</li><li>Assist patients with billing questions, insurance explanations, account balances, and payment options.</li><li>Explain Explanation of Benefits (EOBs) and patient financial obligations in a professional manner.</li></ul><p><b>Payment Posting &amp; Account Reconciliation</b></p><ul><li>Post insurance payments, patient payments, contractual adjustments, and corrections accurately.</li><li>Reconcile account balances and investigate discrepancies.</li><li>Maintain accurate billing and payment records.</li></ul><p><b>Compliance &amp; Reporting</b></p><ul><li>Ensure compliance with HIPAA regulations and payer requirements.</li><li>Maintain confidentiality of patient information at all times.</li><li>Stay current on billing regulations, coding updates, and reimbursement guidelines.</li><li>Prepare reports and billing-related documentation as requested.</li></ul><p><b>Qualifications</b></p><p><b>Required</b></p><ul><li>High school diploma or equivalent.</li><li>Minimum 1&ndash;3 years of medical billing experience in a clinic, hospital, or healthcare billing environment.</li><li>Experience with medical billing software and Electronic Health Record (EHR) systems.</li><li>Knowledge of medical terminology and healthcare reimbursement processes.</li><li>Familiarity with ICD-10, CPT, and HCPCS coding systems.</li><li>Understanding of Medicare, Medicaid, commercial insurance, and coordination of benefits.</li><li>Strong attention to detail and organizational skills.</li><li>Excellent communication and customer service abilities.</li><li>Ability to multitask and prioritize work in a fast-paced environment.</li><li>Proficiency with computers.</li><li>Ability to maintain confidentiality and professionalism when handling sensitive information.</li></ul><p><b>Preferred</b></p><ul><li>Certified Professional Biller (CPB), Certified Billing &amp; Coding Specialist (CBCS), or similar credential.</li></ul><p><b>Benefits</b></p><ul><li>Medical, Dental &amp; Vision Insurance</li><li>Short Term Disability Insurance</li><li>Retirement</li><li>Paid Time Off (PTO)</li><li>Paid Holidays</li></ul><p>Pay: $18.00 - $25.00 per hour</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Medical Billing Specialist

CareMed Specialty Pharmacy

<div><div>We are seeking a Pharmacy Adjudication Specialist at our <b>CareMed Specialty Pharmacy</b> in<b> New Hyde Park, NY. </b>This will be a Full-Time position.<b> </b>This is a <b>remote hybrid opportunity, after onsite training period.</b></div>
<div></div><div><div><b>Shift time currently available: 9:00 am-5:30 pm EST</b></div>
<div></div><div><b>Starting salary from $26.00 an hour and up</b></div>
</div><div></div><div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections</div>
<div></div><div>Pharmacy Adjudication Specialists at CareMed...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.</li>
<li>Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.</li>
<li>Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div><div></div>

Pharmacy Adjudication Specialist

<div><div>We are seeking a Pharmacy Adjudication Specialist at our <b>CareMed Specialty Pharmacy</b> in<b> Waltham, MA. </b>This will be a Full-Time position.<b> </b>This is a <b>remote hybrid opportunity, after onsite training period.</b></div>
<div></div><div><div><b>Shift time currently available: 9:00 am-5:30 pm CST</b></div>
<div></div><div><b>Starting salary from $26.00 an hour and up</b></div>
</div><div></div><div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections</div>
<div></div><div>Pharmacy Adjudication Specialists at CareMed...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.</li>
<li>Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.</li>
<li>Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li>
</ul></li></ul><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div></div><div></div>

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