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As a Pharmacy Claims Coordinator, you will be responsible for the timely and accurate reprocessing of pharmacy claims that require corporate edits. In this role, you will perform work through our RX Connect system on claims to identify trends and issues. Your tasks will include the handling and resolution of high priority Reprocessing requests from both internal and external sources. The main priority of this role is to reduce bad debt by editing claims with corrected information which will prevent future fills from being billed incorrectly.
Job Responsibility:
Timely and accurate reprocessing of pharmacy claims that require corporate edits
Perform work through RX Connect system on claims to identify trends and issues
Handle and resolve high priority Reprocessing requests from both internal and external sources
Reduce bad debt by editing claims with corrected information
Evaluate current practices and procedures to identify and implement team process improvements
Keep process documents updated
Manage workflow within the team's inbox and Reprocessing Database
Attend monthly Reprocessing stakeholder team meetings
Provide training to new hires and established team members
Assist with ServiceNow ticket volume
Requirements:
Active RI Pharmacy Technician II License
Active PTCB certification (CPhT)
2+ years professional experience, preferably in a retail pharmacy or pharmacy call center setting
2+ years using Excel and Outlook in a professional or academic setting
Ability to complete work based on productivity standards (SLA) with minimal supervision
Ability to work individually or with a team to identify and define problems, evaluate alternatives, and implement practical, cost-effective solutions
Must live in RI, MA or CT
Verifiable High School Diploma or GED is required
Nice to have:
1+ year experience with RxConnect System
Ability to interact professionally with business partners (internally and externally)
Excellent verbal and written communication skills
Prompt and concise issue follow up
Ability to quickly make sound decisions while multitasking
Flexibility to adapt to a changing environment
Desire to seek continued professional growth
NCPDP - National Council of Prescription Drug Programs rejection familiarity
Bachelor's degree in Accounting, HealthCare, Finance, or Business
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