Pharmacy Claims Specialist

Job Address:799 Cromwell Park Dr Suites K-M Glen Burnie, MD 21061Pharmacy Claims SpecialistResponsibilities:Responsible for adjudication of daily unit dose and non-unit dose claimsContacting insurance for proper overridesNew 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/familiesReceptionist will mail and Print the packetEnsure documents in ECM Billing folders are worked timelyEnsure Emails to Billing Email are worked timelyAuthorizations – gaining approval from facilities and families on non-covered meds or medication requiring authorizationManage Monthly Adjudication of Cycle Batches/ Unit Dose Reject BatchesWorking assigned Customer Notes in a timely mannerAdding Hospice and VA Med listCubex Temp patients for LTCWork any BI-Call batches for homesAssist billing with rebilling/working open billing batchesCommunicate issues in preventing batches from being posted in a timely mannerAssist with other projects as assigned #J-18808-Ljbffr Pharmacy Solutions Group (PSG)