Pharmacy Claims Reconciliation Specialist (Remote, US)

This job was posted over 30 days ago, so it has most likely closed. See newer jobs like it.

Written by AI from the job title and company, not by House Rx, so some details may not match this job. The employer's own page has the real description.

Job Overview

The Pharmacy Claims Reconciliation Specialist at House Rx will play a critical role in ensuring the accuracy and integrity of pharmacy claims data. This remote position involves reviewing and reconciling claims submissions against reimbursement guidelines, investigating discrepancies, and collaborating closely with pharmacy staff and insurance payers. The specialist will leverage analytical skills to support the optimization of claims processing, enhancing overall pharmacy operational efficiency.

Job Responsibilities

• Review and reconcile pharmacy claims against payer requirements and policies.
• Investigate discrepancies and variances in claims and reimbursement data.
• Prepare and submit adjustments or appeals to claims as necessary.
• Assist in the development and implementation of standard operating procedures for claims reconciliation.
• Collaborate with pharmacy staff to resolve issues and improve claims submission accuracy.
• Maintain accurate records of claims activity and reconciliation efforts.
• Generate reports on claims status and reconciliation outcomes as required.
• Stay updated on changes in pharmacy billing regulations and payer policies.

Qualifications

• Bachelor’s degree in Pharmacy, Business, Finance, or a related field preferred.
• A minimum of 2 years of experience in pharmacy claims processing or related roles.
• Strong understanding of pharmacy billing procedures, insurance claims, and reimbursement processes.
• Proficient in data analysis and reconciliation techniques.
• Excellent attention to detail and problem-solving abilities.
• Strong verbal and written communication skills.
• Ability to work independently and manage multiple priorities in a remote environment.

Technologies & Tools

The Pharmacy Claims Reconciliation Specialist will utilize various technologies and tools to perform their tasks effectively, including pharmacy management systems, electronic claims submission software, and data analysis tools (such as Excel or equivalent). Familiarity with health care databases and relevant regulatory compliance software is also beneficial to perform reconciliation tasks efficiently and accurately.

Ideal Candidates

Ideal candidates for the Pharmacy Claims Reconciliation Specialist role possess a combination of analytical thinking and exceptional organizational skills. They should demonstrate a commitment to accuracy and have a proactive approach to resolving issues. Strong interpersonal skills are essential for effective communication with team members and external partners. A passion for continuous improvement and the ability to adapt to evolving industry standards will further enhance their suitability for this position.