Pharmacy Claims Specialist
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At a glance
Job overview
The Pharmacy Claims Specialist oversees accounts receivable, resolves disputed and denied claims, and ensures accurate payments in line with payer contracts for a U.S.-based healthcare client, collaborating with insurance companies, patients, and internal teams while participating in month‑end closing procedures.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Employment Type: Full-Time Employment
Work Setup: 100% Onsite
Work Schedule: Night Shift (Following U.S. Eastern Time Zone)
Location: Eastwood, Libis, Quezon City
About the Client:
The client is a U.S.-based healthcare company that provides infusion therapy services for patients with chronic and complex medical conditions.
Job Description
The role of the Pharmacy Claims Specialist involves overseeing accounts receivable and minimizing the volume of accounts through the resolution of disputed and denied claims. Additionally, the Account Resolution Specialist will ensure precise payments in alignment with payer contracts.
Job Requirements:
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Review account balances and resolve accounts/invoices by partnering with insurance companies and/or patients.
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Expert in handling appeals and denials.
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Excellent English communication skills.
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Collaborate with various departments to gather necessary information in order to have claims reprocessed or resubmitted.
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Coordinate with the intake team and contracts team to determine the accuracy of information loaded on patient accounts to avoid disputed or underpaid claims.
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Participate in end-of-month closing procedures
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Knowledgeable in NCPDP is a plus
Other Requirements:
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Proficient in Microsoft Office Suite, EMR software, payroll software, and all other software programs.
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Must uphold all principles of confidentiality and patient care to the fullest extent while adhering to and complying with the Health Insurance Portability and Accountability Act (HIPAA) at all times.
What benefits await you by joining Intelassist?
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Global career advancement and networking opportunities.
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Access to both virtual and on-site intensive courses for career and personal development enhancement.
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Monetary rewards for successful referrals that are hired.
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Guaranteed weekends off and a total of 20 paid leave days upon regularization.
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Collaborative work environment
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Eligibility for Health Maintenance Organization (HMO) coverage starting from the first month of employment, with coverage of up to 100,000 PHP per illness.
WHY INTELASSIST?
We grow together. We value your effort. We aim to empower you.
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