Pharmacy Claims Processor

Job not on LinkedIn

🔥 1 minute ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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👻 Ghost score 10%

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Okta

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2010

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Okta is a leading provider of identity management solutions, offering both Customer Identity and Workforce Identity Clouds to ensure seamless and secure access for organizations across various industries. With a focus on flexibility, neutrality, and extensibility, Okta enables businesses to create high-performing IT systems and optimized digital experiences while maintaining top-notch security. Their platform supports a wide range of use cases including single sign-on, multifactor authentication, and identity governance, helping companies across sectors like finance, healthcare, government, and retail to manage identities efficiently. Okta continues to lead in identity access management, as highlighted by its recognition in the Gartner Magic Quadrant.

📋 Description

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing • Research, analyze, and resolve rejected claims with Medicare D plans, third-party insurance companies, and state Medicaid plans • Perform edits and/or reversals to obtain claim approval and maximize payer reimbursement • Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes • Identify, document, communicate, and resolve payer and billing trends and issues as part of a team • Review and convert billing exception reports to ensure claims are billed to accurate financial plans • Prepare and maintain processing reports and records • Perform other assigned tasks

🎯 Requirements

• High School Diploma or GED required • Customer Service experience required • Ability to retain a large amount of information and apply that knowledge to related situations • Ability to work in a fast-paced environment • Basic math aptitude • Microsoft Office Suite • Associate’s or Bachelor’s Degree desired • Up to one year of related experience desired • Pharmacy Technician experience desired • Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters desired • Pharmacy technician certification desired but not required

🏖️ Benefits

• DailyPay • Flexible Schedules • Competitive Pay with Shift Differentials • Health, Dental, Vision, and Life Insurance • Company-Paid Disability Insurance • Tuition Assistance & Reimbursement • Employee Discount Program • 401k Plan • Paid Time Off • Non-Retail, Closed-Door Environment • 100% remote work

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