Pharmacy Claims Specialist - Remote Job at AmeriHealth Caritas
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
- Collect, post and manage account payments
- Submit claims, audit claims and follow up with insurance companies
- Prepare and submit clean claims to insurance companies electronically or by paper
- Audit claims after submission and correct errors
- Respond to insurance audit requests in a timely manner
- Review month-end reports, revenue, cash and adjustments for accuracy
- Answer questions from patients, staff and insurance companies
- Identify and resolve patient billing complaints
- Prepare, review and send patient statements
- Evaluate patient financial status and establishes budget payment plans; monitor and report status of delinquent accounts
- Review accounts for possible assignment and make recommendations to the Billing Supervisor; prepare information for the collection agency
- Assist patients in locating financial assistance programs for monies due for medications
- Prepare daily reports and performs financial system maintenance as required
- Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
- Process payments from insurance companies and prepares a daily deposit
- Participate in educational activities and attends monthly staff meetings
- Conduct self in accordance with company’s employee manual
- Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations
Education/Experience:
- High School Diploma or equivalent required
- Minimum one (1) year of specialty pharmacy billing experience required
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