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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 billing processes and capable of maintaining accurate records while providing excellent customer service.
Highest-signal resume keywords
Pharmacy Technician ExperienceClaims AnalysisBilling ProcessesCustomer ServiceMicrosoft Office Suite
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 ManagementPayer ReimbursementBilling Exception ReportsBasic Math AptitudePharmaceutical Knowledge
Soft Skills
Ability To Retain InformationFast-Paced Work AdaptabilityTeam Communication
Certifications & Qualifications
Pharmacy Technician Certification
Industry Keywords
Medicare Part DThird-Party InsuranceState Medicaid PlansRevenue MonitoringBilling Trends
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 Part D plans, third-party insurance companies, and state Medicaid plans
- Perform edits and/or reversals to obtain claim approvals and maximize payer reimbursement
- Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes
- Identify, document, communicate, and resolve payer and billing trends and issues as part of a team
- 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
- Customer Service experience
- 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
- Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference
- Associate’s or Bachelor’s Degree is desired, but not required
- Pharmacy technician certification is desired, but not required
- Willingness to learn claims, billing, and insurance processing
- Availability for nights and weekends
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