Claims Specialist

Job Description

Job Description

Elite Care Rx is a professional Pharmaceutical and Claim Management Company headquartered in beautiful Oviedo, Florida. With nearly two decades of experience, we’ve earned a reputation of being the industry leader and expert in pharmaceutical programs dedicated to the treatment of industrial and auto accident injuries. Through our programs, injured workers obtain more convenient and much needed access to medically necessary prescriptions and care that may otherwise be difficult for them to receive when navigating the challenges related to the treatment of a patient in the workers compensation realm.

We pride ourselves on being a management company that was built from a billing and collection infrastructure. Quality employees are the lifeblood of a company and at Elite Care Rx we invest in top level domestic billers and claim specialists. With the dedication and expertise of our team, providers are better able to adequately treat their patients, and injured workers are better able to receive the care they need to recover from their ailments, receive relief from symptoms, and ultimately heal in order to return to work and normal life functions.

Responsibilities and Duties

• Utilize A/R reports and identify accounts that are past due. Contact insurance carriers, adjusters, PBMs, and TPAs to verify claim information and learn status of payment.
• Receive payment on delinquent orders through correcting and resubmitting any claims with billing errors, drafting formal appeals to overturn denials, and clear, concise communication with TPAs, bill review vendors, and insurance adjusters.
• Organize daily workflow and follow up on accounts as necessary
• Escalate accounts and unpaid prescriptions as necessary
• Keep detailed notes in billing software system advising of all communications and actions to resolve account

Qualifications and Education Requirements:

High School Diploma. College degree preferred.

• Previous experience in medical billing or claim processing
• Effective in utilizing Microsoft Office and other software programs
• Excellent written and verbal communication skills
• Ability to prioritize and multitask
• Strong math and analytical skills

Preferred Skills:

• Background and experience in pharmacy and medical terminology a plus, but not required
• Working knowledge of an EOB and HCFA
• Worker’s compensation and/or personal injury claim experience is a plus

*** Overall, experience is preferred but not required as in-depth training is provided!! ***

- Starting wages negotiable based on experience and quality of interview. -