information as requested or properly authorized. The Medical Claims Specialist will take steps necessary to resolve all claim... meetings, trainings, and conferences.* Under the direction of the Manager of Revenue Cycle Management, the Medical Claims...
, secondary, tertiary, etc. insurances and medical insurances to patient profile. Run test claims at each licensed pharmacy site... for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication...
... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing... Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims...
authorization requests. Pharmacy Prior Authorization Specialist Primary Responsibilities: Assist with medical necessity.../understanding of pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim...
billing, monitoring and collections of Medicaid, Managed Medicaid payers, and private insurance payers. Must possess critical... claims to Medicaid, Managed Medicaid payers, and private insurance payers, follow-up on submitted claims in accordance...
with insurance payors to ensure favorable reimbursement rates, efficient claims processing, and overall network optimization... as a liaison between payors and supported practices, this role provides guidance on contract terms, credentialing, and claims...