- Henry Ford Health System (Detroit, MI)
- …role supports patients' medication access by managing infusion and injection benefit claims , ensuring financial viability, and addressing affordability concerns ... throughout the care journey. * Claims Authorization Support: Efficiently validate insurance coverage and determine...qualifications: * Minimum of 2 years' experience in a pharmacy setting, with experience in medication benefits … more
- PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
- …perspective and experience makes ConnectiveRx better than the sum of its parts. The Claims Specialist , under the direction of the Supervisor (with guidance from ... 1+ years in a health care or case management setting + Experience working in pharmacy benefits , health care insurance, and/or medical billing a must + Health… more
- AssistRx (Phoenix, AZ)
- The Copay Support/ Claims Processing Specialist is a critical role within the organization and is responsible for servicing inbound calls, EOB faxes, and mail ... reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication, troubleshoot claim rejections, claim… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** SHP Pharmacy Benefits Specialist (Remote in WI)) **Cost Center:** 682891381 ... **Job Description:** **JOB SUMMARY** The Security Health Plan (SHP) Pharmacy Benefit Specialist is responsible... benefits . This individual works closely with the Pharmacy Director, Clinical Pharmacy Specialist ,… more
- Baylor Scott & White Health (Temple, TX)
- … 2 communicates with members, providers, and clients to explain Health Plan pharmacy benefits , assist with understanding the prior authorization process, and ... identify root causes and address concerns. In addition, the Pharmacy Services Specialist 2 serves in a... processing issues for all Health Plan products, utilizing pharmacy claims systems and appropriate departmental tools.… more
- Northwell Health (New Hyde Park, NY)
- …utilization management (UM) criteria, and evidence-based drug therapy guidelines, and overseeing pharmacy benefit claims adjudication to match formulary ... **Req Number** 171104 **Job Description** The Clinical Pharmacy Specialist is responsible for the...management (PA, ST, QL) criteria development + Experience with benefit design, claims data analysis, and drug… more
- St. Luke's Health System (Boise, ID)
- …of colleagues, St. Luke's is truly a great place to work. **Overview:** The Pharmacy Benefits Specialist assists our members in identifying and navigating ... complex pharmacy benefits management (PBM) and third-party issues...authorization requests for medications under the pharmacy benefits . + Facilitate resolutions to issues involving claims… more
- Trinity Health (Ann Arbor, MI)
- **Employment Type:** Part time **Shift:** Day Shift **Description:** ** Pharmacy Tech Specialist - Home Infusion** **Department:** Home Infusion **Location:** ... the drug inventory. Performs all job functions of the Pharmacy Technician Specialist as needed/appropriate for the...Billing Assistance + Drug card billing for home infusion pharmacy patients, troubleshoot claims rejections, finalize and… more
- UPMC (Bridgeville, PA)
- …according to line of business + HS diploma or equivalent required + 2 years of pharmacy claims , pharmacy tech, and/or other related experience in a physician ... UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their...or other relevant healthcare setting required. + Experience in pharmacy claims process operating system required. +… more
- Trinity Health (Fort Wayne, IN)
- …and provides information to patients and providers as it pertains to the patient's pharmacy benefits . Determines if prior authorization is needed for the claim ... **Employment Type:** Full time **Shift:** **Description:** The Specialty Pharmacy Revenue Cycle Specialist is responsible for performing the appropriate… more
- Insight Global (Robinson, PA)
- Job Description A closed door pharmacy is looking to hire a Pharmacy Benefits Specialist . This role will include processing pharmacy claims , ... triaging rejected claims , and verifying benefits . Prior Pharmacy benefits experience is required as well as the ability to multitask. Shifts: This is a… more
- UPMC (Pittsburgh, PA)
- …to CMS, DPW, DHHS, HCFA, DOI and NCQA laws and standards. + HS diploma and pharmacy claims , pharmacy tech, and/or other related experience in a physician ... UPMC Health Plan is looking for Pharmacy Clinical Review Specialist I positions...or other relevant healthcare setting required. + Competent in pharmacy claims process operating system. + Excellent… more
- UNC Health Care (Chapel Hill, NC)
- …start of referral to payor reimbursement back into our system; this includes benefits investigations and daily claim filing (both pharmacy and medical). Performs ... communities we serve. Summary: We're a small but mighty 340B HTC specialty pharmacy serving about 300 patients with bleeding disorders throughout the State of North… more
- SSM Health (St. Louis, MO)
- …authorization services. Develops a thorough understanding of payer reimbursement and patterns for pharmacy and medical claims with third parties. + Serves as ... include but are not limited to third party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers… more
- Centene Corporation (Austin, TX)
- …- Friday; 2:00 pm - 10:30 pm EST, schedule.** **Position Purpose:** The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles ... team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Applicants...more complex pharmacy issues and respond to escalated calls from members,… more
- Insight Global (Robinson, PA)
- …- High school diploma or GED - Flexibly to work shifts ranging from 8 am - 8 pm Bachelors Pharmacy Tech License Knowledge of Pharmacy Benefits and Claims ... in the Robinson Township, PA area is looking to hire a Pharmacy Prior Authorization Specialist . This role will include assisting in the initiation of new prior… more
- AssistRx (Maitland, FL)
- …care providers and patients Requirements + In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage + 2 to 3 years of benefit ... coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding… more
- Meriter-UnityPoint Health (Madison, WI)
- …for maintaining high personal standards of customer service and satisfaction. The Discharge Specialist Pharmacy Technician is a position in the Outpatient ... Pharmacy . The Discharge Specialist is responsible for facilitating and expediting the medication-related...proactively obtaining payment information for patients using Meriter Outpatient Pharmacy at discharge, processing test claims for… more
- Ardon (Portland, OR)
- … software system work queues. Must be able to understand and interpret claims adjudication issues with Pharmacy Benefit Management organizations, insurance ... Must be able to accurately utilize applicable computer software and equipment for pharmacy claims processing. Working conditions Work is performed primarily at a… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …JOB SUMMARY: The Adjudication Specialist manages a portfolio of rejected pharmacy claims , ensuring timely billing and maximum payer reimbursement. They ... Shift Night Shift Description WHO WE ARE At Polaris Pharmacy Services, we're more than a pharmacy ...and ensure compliance with policy terms. + Resolve Rejected Claims : + Calculate benefit payments and approve… more