Part D Claims Specialist

🔥 1 minute ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $24 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

InnovAge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

InnovAge is a provider of the Program of All-inclusive Care for the Elderly (PACE) that helps frail seniors remain independent and age in their own homes with dignity. As the largest PACE provider by participants served, InnovAge delivers comprehensive, coordinated services including primary care, nursing, behavioral health, therapies, transportation and care coordination to support seniors' medical and daily living needs.

📋 Description

• Manage and reconcile Part A claims and stays • Perform Part D compliance tasks, including B vs D, ESRD, and Medical Necessity • Manage participant plan enrollment status with the pharmacy and PBM • Ensure claims are billed to Part D appropriately based on CMS regulations and EMR documentation • Download and review weekly, monthly, and quarterly Part D and PBM reports and take necessary actions • Download and review CMS reports and take necessary actions • Reconcile rejected claims and submission concerns with pharmacies and the PBM • Assist in reconciling PDE data • Summarize and report PDE progress • Prepare, submit, and analyze PDE submissions to CMS • Stay current on pharmacological updates and Medicare Part D guidelines • Coordinate with Medicare and Medicaid specialists as needed • Work with finance and billing specialists on bill resolution • Manage provider credentials for the PBM and contracted pharmacy • Perform other duties as needed • Work independently in a work-from-home position while managing large volumes of data

🎯 Requirements

• 3+ years working with medical and/or pharmacy claims • Current advanced knowledge of medication names, dosages, indications, and routes of administration • Experience and comfort navigating EMR and interpreting EMR data • Advanced Excel skills for managing large volumes of data, including formulas, pivots, and reports • Ability to solve problems under pressure • Strong attention to detail and ability to prioritize workload • Comfortable working independently • Excellent communication and organization skills • Strong computer skills, including word processors, spreadsheets, and database software • Associate’s degree or formal training beyond high school in lieu of an Associate’s degree • Florida applicants require background screening through the Florida Care Provider Background Screening Clearinghouse • Preferred: experience with EPIC EMR • Preferred: experience managing patient plan eligibility • Preferred: experience in a PACE or similar healthcare program • Preferred: knowledge of Medicare Part D regulations and compliance requirements • Bachelor’s degree preferred

🏖️ Benefits

• Medical, dental, and vision insurance • Short- and long-term disability insurance • Life insurance and AD&D • Supplemental life insurance • Flexible spending accounts • 401(k) savings plan with company match • Paid time off • Company-paid holidays • Equal opportunity and affirmative action workplace • Diverse and inclusive workplace • Patient-centered care model • Work-from-home position

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume