- Location
- Pharmacy Solutions Group Maryland, United States of America
- Type
- Full-time
- Department
- Healthcare
- Education
- Master
- Source
- Workday
Description
Job Address:
799 Cromwell Park Dr Suites K-M Glen Burnie, MD 21061
Pharmacy Claims Specialist
Responsibilities:
Responsible for adjudication of daily unit dose and non-unit dose claims
Contacting insurance for proper overrides
New Admits for assigned homes (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.
Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
Welcome Packets – prepare Welcome Packet to all new PVT patients/families
Receptionist will mail and Print the packet
Ensure documents in ECM Billing folders are worked timely
Ensure Emails to Billing Email are worked timely
Authorizations – gaining approval from facilities and families on non-covered meds or medication requiring authorization
Manage Monthly Adjudication of Cycle Batches/ Unit Dose Reject Batches
Working assigned Customer Notes in a timely manner
Adding Hospice and VA Med list
Cubex Temp patients for LTC
Work any BI-Call batches for homes
Assist billing with rebilling/working open billing batches
Communicate issues in preventing batches from being posted in a timely manner
Assist with other projects as assigned
