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Description:

Day to day includes census (skilled nursing facilities and making sure reports are updated) and admissions, adjudication of all claims from pharmacy, customer service, working with prior authorizations, also has skilled business so billing on that as well (Medicaid and managed care)

hybrid billing department

adjudication of claims for pharmacy

census; PA, insurance authorizations

Skilled business; billing and doing census for Medicaid part A and then managed care

Mixture of inbound and outbound of calls

Family members, nurses, Med tech

Previous Role : come from the pharmacy, they need the knowledge of the medication to understand the backside of the business. Retail candidate have been more successful. Would like a min of 2 years of experience, would take anyone if it's a year.

Skills:

claims adjudication, Pharmacy, Data entry, Customer service, Prior authorization, Retail pharmacy, Call center, Insurance, Pharmacy technician certification, Cpht

Additional Skills & Qualifications:

Would prefer to have FrameWork exp, but not necessary

Soft Skills:

Attention to detail

Multitask

Being able to work independently

Experience Level:

Intermediate Level

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