Full-Time
LocationsShowing 1 location
REMOTE Anywhere in the USA
Remote, Remote, USA
Job Details
Description
The Reimbursement Coordinator is responsible for performing the direct member reimbursement (DMR) functions and supporting senior level management. This position has no direct reports.
Department: Clinical Operations
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Open, date, time stamp and count incoming mail
Sort and file incoming claims that need to be processed
Process Medicare, commercial and Veteran Administration claims
Create letters and labels for all denied claims as well as Medicare paid claims
Scan, rename and electronically file all claims
Contact Medicare members regarding determination of request
Provide support to customer service, client services and upper management
Adhere to standard operating procedures for processing all types of coordination of benefits (COB) claims; periodically update procedure if process changes
Other duties as assigned
REQUIREMENTS:
High school diploma or GED
A knowledgeable individual with appropriate industry experience, preferably in the healthcare, insurance or PBM
industry
Strong data analysis and presentation skills
Ability to exercise considerable judgment, maintain confidentiality and act in a diplomatic manner
Effective verbal and written communication skills
Ability to work with peers in a team effort
Demonstrated ability to manage multiple priorities and deadlines
A well-organized and self-directed individual who is able to work with minimal amount of supervision
Capability to efficiently complete tasks in a fast paced environment
Ability to work extended hours, weekends and holidays pursuant with industry demands
Proficient in Microsoft Office and industry related software programs
PREFERRED QUALIFICATIONS:
Bachelor’s degree
Certified, Licensed or Registered Pharmacy Technician
Medicare Part D knowledge
Pharmacy claim analysis experience
Bilingual in English and Spanish