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Pharmacy Claims Representative
Columbus
, OHPharmacy Claims Representative
Columbus, OH
Hybrid
As the Pharmacy Claims Representative, you will be responsible for reviewing, analyzing, and resolving pharmacy insurance claims. This role involves investigating claim details such as method of payment, co-pay or deductible amounts, and reasons for denial, while ensuring all transactions meet established policies and quality standards. You’ll work closely with internal teams and healthcare partners to ensure accuracy, compliance, and timely processing of pharmacy claims. The position offers some flexibility in managing your workload while maintaining a strong focus on accuracy and customer satisfaction.
Pharmacy Claims Representative Responsibilities:
Analyze and resolve pharmacy claims issues, including payment discrepancies and denial reasons.
Respond to inquiries from patients, pharmacies, and insurance providers regarding claim status and billing details.
Interpret and apply department policies and insurance guidelines to ensure proper claim adjudication.
Maintain documentation and records of claim resolutions in accordance with company and regulatory standards.
Work collaboratively with internal pharmacy and billing teams to ensure timely and accurate claim processing.
Identify trends or issues that may require process improvement or escalation.
Pharmacy Claims Representative Requirements:
Active state Pharmacy Technician license in state of residence.
National Certification through PTCB or ExCPT (must be submitted with resume).
Eligible to work with Medicare and Medicaid programs.
Previous experience in pharmacy billing, claims processing, or a related healthcare setting preferred.
Strong attention to detail and analytical problem-solving skills.
Excellent communication and organizational abilities.
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