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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing pharmacy claims, ensuring maximum payer reimbursement through effective analysis and resolution of rejected claims. Proficient in collaborating with teams to identify billing trends and maintain accurate processing records.
Highest-signal resume keywords
Pharmacy Claims ManagementPayer Reimbursement OptimizationCustomer Service ExperiencePharmacy Technician CertificationInsurance Industry Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisBilling ResolutionBasic Math AptitudeReport PreparationData Documentation
Soft Skills
Information RetentionFast-Paced Work Adaptability
Tools & Technologies
Microsoft Office Suite
Certifications & Qualifications
Pharmacy Technician Certification
Industry Keywords
Medicare D PlansThird-Party InsuranceState Medicaid PlansBilling TrendsRegulatory Considerations
About the role
Key responsibilities & impact- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing
- Research, analyze, and resolve rejected claims with Medicare D plans, third-party insurance companies, and state Medicaid plans
- Perform edits and/or reversals to obtain claim approval and maximize payer reimbursement
- Monitor and resolve at-risk revenue related to payer setup, billing, rebilling, and reversal processes
- Collaborate with the team to identify, document, communicate, and resolve payer and billing trends and issues
- Review and convert billing exception reports to ensure claims are billed to accurate financial plans
- Prepare and maintain processing reports and records
- Perform other assigned tasks
Requirements
What you’ll need- High School Diploma or GED required
- Customer Service experience required
- Ability to retain a large amount of information and apply that knowledge to related situations
- Ability to work in a fast-paced environment
- Basic math aptitude
- Microsoft Office Suite
- Associate’s or Bachelor’s Degree desired
- Up to one year of related experience desired
- Pharmacy Technician experience desired
- Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters desired
- Pharmacy technician certification desired but not required
Benefits
Comp & perks- DailyPay
- Flexible Schedules
- Competitive Pay with Shift Differentials
- Health, Dental, Vision, and Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
- 100% remote work