Address
Form of workOrsini Specialty Pharmacy is a nationwide specialty pharmacy focused on providing exceptional care to patients throughout their journey. We focus on disease programs that require a high-touch patient experience and provide those we care for genuine empathy and compassion as part of our service delivery.
POSITION SUMMARY
The Claims Denial Clerk is responsible obtaining status of claims once they age beyond a specified time range. The claims clerk will submit simple documentation requested by payors to get claims paid. The CDC will work with the Collection manager, billing team and auditor on denials that require a higher level of attention such as appeals, grievances rebills etc. The CDC will check and advise BV team when claims deny for eligibility issues. The Claims Denial clerk will assist with a any other duty assigned as needed.
REQUIRED KNOWLEDGE, SKILLS & TRAINING
- Minimum 1 year of experience in patient accounts, BV and/or collections preferably specialty pharmacy.
- Familiar with AR and operational health care systems.
- Experience with Microsoft applications. (Excel, Word, PowerPoint, etc)
- Familiar with medical terminology.
- Experience with billing.
- Able to multitask and utilize excel in a fast-paced working environment.
- Able to problem solve and assist coworkers through the thought process of solving problems.
- Collaborate on best practices for efficiency and streamlines communication throughout teams.
ESSENTIAL JOB DUTIES
- Provide claim status on outstanding claims
- Research denials takes necessary action to resolve requests
- Utilizes the most efficient resources to resolve denials quickly
- Identifies short payments, over payments, unpaid claims, and resolves accordingly. Reviews residual balances after payments are applied and generates necessary adjustments, overpayment notification, refund requests
- Work with copay assistance plan to obtain eligibility to determine if patient was active during the DOS that we are billing
- Work with copay assistance plan to confirm that funds are still available initiate transfer
- Communicate with the PCC Team when patients are no longer active with the copay assistance plan
- Ability to work remotely
- Ability to be flexible and assist with other projects when needed.
EMPLOYEE BENEFITS
- BCBSL Medical
- Delta Dental
- EyeMed Vision
- 401k
- Accident & Critical Illness
- Life Insurance
- PTO, Holiday Pay, and Floating Holidays
- Tuition Reimbursement
