Claims Specialist

Location: Tarentum, PA

Department: Claims Department

At Blackburn's Physicians Pharmacy, our mission is simple: People first, Be kind, & Work together, for our patients, our employees, and our community . We are seeking a detail-oriented and motivated Claims Processing Specialist to join our growing Claims Department and help ensure timely, accurate, and compliant insurance claim processing for the patients we serve.

This role is ideal for someone who thrives in a fast-paced healthcare environment and has experience with medical billing, insurance authorizations, claims follow-up, or healthcare documentation.

Position Summary

The Claims Processing Specialist is responsible for managing third-party medical claims, insurance documentation, and reauthorization processes to support uninterrupted patient care and timely reimbursement. This position plays a key role in reducing denials, maintaining compliance, and supporting operational efficiency across the claims process.

Success in this role requires strong organizational skills, attention to detail, effective communication, and the ability to manage multiple priorities while meeting strict filing deadlines.

Key Responsibilities

• Process and review third-party medical claims for accuracy, completeness, and compliance
• Manage insurance documentation, authorizations, and requalification requirements
• Verify benefits, authorization requirements, and payer guidelines for various insurance plans
• Create, submit, monitor, and track documentation and authorization requests in a timely manner
• Follow up on prescription renewals and required documentation to avoid delays in patient care
• Work collaboratively with internal departments, providers, patients, and insurance payers to resolve claim issues and denials
• Utilize reporting tools and work queues to prioritize follow-up and maintain productivity
• Identify trends impacting reimbursement or claims processing and communicate findings to management
• Assist with denial resolution and process improvement initiatives to increase efficiency and reduce write-offs
• Maintain accurate records and ensure all documentation is audit-ready
• Support additional departmental projects and responsibilities as assigned

What We Offer

• Meaningful work that directly supports patients receiving essential healthcare equipment and services
• A collaborative and supportive team environment
• Opportunities for ongoing training, professional development, and career growth
• Competitive compensation and benefits
• A mission-driven workplace where your contributions make a real difference every day

Qualifications

• Strong attention to detail with excellent organizational and time-management skills
• Effective written and verbal communication abilities
• Ability to manage multiple tasks and work efficiently in a deadline-driven environment
• Strong interpersonal skills and ability to collaborate across teams
• Proficient computer and data-entry skills
• Experience in healthcare, medical billing, DME/HME, or insurance claims processing preferred
• Knowledge of medical third-party billing and insurance authorization processes preferred
• Familiarity with Medicare, Medicaid, and commercial insurance plans is a plus
• Microsoft Word and Excel experience preferred