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CF
CommuniCare’s Family of Companies
Pharmacy Claims Specialist
Career Insights for Claims Adjuster / Specialist (General)
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Based on Maryland data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$78,916 / year median in Maryland
+12% projected growth
Job Description
Pharmacy Claims Specialist
Job Address:
799 Cromwell Park DrSuites K-MGlen Burnie, MD 21061Pharmacy Claims SpecialistResponsibilities:
Responsible for adjudication of daily unit dose and non-unit dose claims- Contacting insurance for proper overridesNew Admits for assigned homes (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
- Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.
- Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
- Welcome Packets - prepare Welcome Packet to all new PVT patients/families
- Receptionist will mail and Print the packetEnsure documents in ECM Billing folders are worked timelyEnsure Emails to Billing Email are worked timelyAuthorizations - gaining approval from facilities and families on non-covered meds or medication requiring authorizationManage Monthly Adjudication of Cycle Batches/ Unit Dose Reject BatchesWorking assigned Customer Notes in a timely mannerAdding Hospice and VA Med listCubex Temp patients for LTCWork any BI-Call batches for homesAssist billing with rebilling/working open billing batches•Communicate issues in preventing batches from being posted in a timely mannerAssist with other projects as assigned