Claims Specialist

Overview:

When you join the PharmaGenetics INC team you will be apart of a growing, dedicated staff who help to get safe, accurate, and timely medication to those who need it most.

Position Summary
Reviews and adjudicates routine Medicare claims on HRP system in accordance with claim processing guidelines. Claims adjudication results should meet/exceed production and quality standards in line with CMS and Aetna compliance and business requirements. Analyzes and approves routine claims that cannot be auto adjudicated.

Responsibilities/Duties

• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters
• Utilizes all applicable system functions available ensuring accurate and timely claim processing

Required Qualifications

• Experience in a production environment
• Detailed and quality oriented
• Ability to research and work within several computer applications simultaneously
• Microsoft Outlook

Preferred Qualifications

• Claim processing experience
• Computer Navigation Proficiency
• Production & Quality background
• Microsoft Office tools

Education
High School or GED equivalent

At Pharmagenetics INC we make employment decisions based on the needs of our business and the qualifications of the individual and do not discriminate based upon race, religion, color, national origin, gender (including pregnancy or other medical conditions/needs), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. We encourage all to apply.

Job Type: Full-time

Pay: $22.63 - $27.25 per hour

Expected hours: 42 per week

Benefits:

• 401(k)
• Health insurance
• Paid time off

Schedule:

• Monday to Friday
• Weekends as needed

Work setting:

• In-person

Ability to Relocate:

• Chicago, IL: Relocate before starting work (Required)

Work Location: In person