Pharmacy Third-Party Specialist

Job Description

Job Description

Department: PharmacyPosition Status: Non-exemptFLSA Level: VariesPosition Summary: The Pharmacy Third-Party specialist focuses on managing and resolving issues related to the third-party insurance claims and billing in a pharmacy setting. this position will be able to pick their main location between our Jamestown or Dunkirk location.Supervisory Responsibilities:NoneEssential Functions/Responsibilities of the Position:Ensuring accuracy and completeness of information for timely and accurate reimbursement.Investigating and addressing rejected claims, working with insurance companies to obtain necessary information, corrections and prior authorizations.Ensuring timely payment and resolving any discrepancies.Keeping detailed records of claims, billing and reimbursements while staying up to date on insurance company policies and procedures.Acting as a point of contact between the pharmacy staff, patients and insurance companies.Assisting pharmacy staff and patients with billing related questions or issues.Contributing to the development of effective billing practices.Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)Other duties as assigned.Position Qualifications:EDUCATION: High School Diploma or equivalent General Education Development (GED) certificateEXPERIENCE (Years & Certifications):Certified Pharmacy Technician (CPhT) preferredSKILLS: Strong understanding of medical terminology and pharmacy-related concepts.Customer service skills to handle patient needs effectively and efficiently.Proficiency in Microsoft Office Suite.Ability to work independently or as part of a team.Capability to identify problems, analyze options and implement effective strategies to overcome obstacles.Ability to manage multiple tasks, prioritize workload and maintain accurate records.Capacity to handle fast paced environment to meet deadlines.Position Requirements and Working Conditions: Physical ActivitiesFrequency(N)Never - 0%, (O)Occasionally - 50% or (C)Constantly - 100%Ascending or descending stairs and the like.NRemaining in a stationary position, often standing or sitting for prolonged periods.CMoving about to accomplish tasks.OCommunicating with others to exchange information.CRepeating motions that may include the wrists, hands and/or fingers.CTravel to meet with various stakeholdersNAssess risk, detect risk factors for site safety purposes through being aware of surrounding environment, individuals, noises, observations, etc.NEnvironmental ConditionsFrequency(N)Never - 0%, (O)Occasionally - 50% or (C)Constantly - 100%Low temperatures.NHigh temperatures.NOutdoor elements such as precipitation and wind.NNoisy environments.NHazardous conditions.NPoor ventilation.NSmall and/or enclosed spaces.NAdverse environmental conditions expected.NPhysical DemandsFrequency(N)Never - 0%, (O)Occasionally - 50% or (C)Constantly - 100%Sedentary work that primarily involves sitting/standing.CLight work that includes moving objects up to 20 pounds.NMedium work that includes moving objects up to 50 pounds.NHeavy work that includes moving objects up to 100 pounds or more.NEEO StatementThe Chautauqua Center is an Equal Opportunity Employer and considers all candidates for employment regardless of race, color, national origin, religion, sex, age, disability, citizenship, pregnancy, military status, marital status, sexual orientation, or any other characteristics protected by law.