We are looking for a Pharmacy Technician to work in the Medical Claims department of a Specialty Pharmacy in Garden Grove, CA.
Perform functions to review submitted claims and required documentation to ensure accurate and timely reimbursements, working within the limits of standard or accepted practice.
- Gather and compile Detailed Written Orders (DWOs) and other documentation required for Medicare claims submissions. Ensure that all documentation is included in order to expedite payment and minimize claims rejection.
- Evaluate claims submissions and margin reports and notify management of the status of submissions.
- Investigate and identify benefits available for new transplant Medicare Part B patients.
- Review, evaluate, and identify solutions to improve effectiveness and decrease collection time on individual challenging cases.
- Identify and contribute to the resolution of potential reimbursement issues where cases involve denied or delayed payments, low margin drugs/payers, and other situations which reduce revenue.
- Assist with month-end closing to ensure maximum claims resolution.
- Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements.
- Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies.
- Perform other related duties as assigned.
- Maintain Certified Pharmacy Technician License.
- Proven ability to quickly learn the organization’s computer business systems used in claims submission and tracking.