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Claims Collection Account Specialist

Valuecare Pharmacy Inc

Position Overview:

We are seeking an energetic, goal-oriented Claims Collection Specialist. If you are driven to achieve, here is your chance to be part of a stable, strong growing company and be rewarded for your hard work and contributions towards company goals and objectives. Valuecare Pharmacy is a national pharmacy service working on behalf of injured patients. We are a market leader and rapidly expanding resource to injured patients and their advocates. When you join our fast-paced winning team, you’ll share in the continued success of a profitable, thriving, and unique pharmacy service.

Under general supervision, performs a variety of professional duties in support of Valuecare Pharmacy injured patients pharmacy services. This position is responsible to expedite payment from Workers’ Compensation and No-Fault Insurance Carriers, monitor electronic billing rejections and maintain accounts receivable. The position requires constant contact by phone and email with insurance carriers, third-party administrators, and pharmacy benefit managers.

Essential Duties/Responsibilities:

  • Review, Investigate, and Analyze workers’ compensation and/or auto injury claims to maximize recovery.
  • Monitors billing rejections and takes appropriate action.
  • Ensures invoices are on file and obtains the status of billing less than 65 days outstanding.
  • Develop and maintain internal systems for data collection and entry, financial analysis, and report generation; create and update spreadsheets, logs, and diary as necessary.
  • Serve as a liaison between insurance carriers, pharmacy benefit managers, patients, and internal company divisions.
  • Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action. Stay abreast of new trends, pending legislation, and case law related to workers’ compensation.
  • Negotiate settlements with insurance carriers to obtain the maximum recovery.

Required Skills Skills:

  • Communicate clearly and concisely, both orally and in writing.
  • Detail orientated.
  • Strong organizational and time management.
  • Problem solving
  • Gather, organize, compile, and summarize data.

Abilities:

  • Able to work well independently and as part of a team.
  • Interpret and apply state and federal workers’ compensation regulations.
  • Ability to effectively manage change in regards to state and federal regulations and statutes as well as internal organizational operation.
  • Promptly respond to requests and inquiries.
  • Establish and Maintain effective working relationships with those contacted in course of work.

Company Competencies:

  • Communication – listening, informing
  • Patient Focus – compassion, customer focus, functional & technical skills
  • Results – creativity, perseverance, action-oriented, results driven
  • Quality – problem-solving, decision quality, time management, total works systems
  • Professionalism – self-knowledge, ethics & values, integrity trust, and interpersonal savvy

Physical Demands/Working Conditions:

  • Work is typically performed in an office environment with some physical demands such as: sitting for long periods of time (6-8 hours per day) bending, stretching, lifting, typing, speaking, hearing, handling, identifying, lifting up to 20 lbs., near acuity/clarity with or without correction, subject to inside environmental conditions but not necessarily from temperature changes, subject to moderate noise, and normal exposure to everyday risks and discomfort requiring common safety precautions.
  • While performing the duties of this job, the employee is regularly required to communicate professionally in person, over the telephone, through email and other electronic means, handle various types of media and equipment, and visually or otherwise identify, observe and assess. Responsibilities occasionally may require an adjusted work schedule, overtime, and evening hours in order to meet deadlines.
  • The work environment characteristics described above are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

NOTE: This job description is intended to describe the general nature and level of the work being performed by employees in the position. It is not intended to be a complete list of all responsibilities, duties, and skills for the position. Valuecare Pharmacy reserves the right at all times, in its sole discretion, to add or subtract duties and responsibilities, as it deems necessary.

Valuecare Pharmacy is an Equal Opportunity Employer.

Education:

  • Bachelor’s Degree or equivalent experience.
  • 1+ years Workers Compensation knowledge.
  • Medical and technical terminology used in industrial injury cases.
  • Basic principles and practices of analytical, statistical, and financial report preparation.
  • Modern office procedures and methods including computer equipment and supporting applications.

 

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