Case worker Jobs in Raleigh nc

job summary : Responsibilities :

• Process and perform adjudication of specialty pharmacy claims through point of sale functions.
• Manage assigned queues keeping up-to-date and current on all claims.
• Serve as a technical resource pertaining to adjudication while identifying areas for improvement.
• Interact with other teams and function in strict accordance with standard, written procedures, and guidelines.
• Enter detailed, accurate, and grammatically correct progress notes.
• Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
• Obtains payer specific prior authorization procedures and documentation requirements if applicable and facilitate the prior authorization process for patients and healthcare providers.
• Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate.
• Position may require sales, project management and / or account coordination skills depending on the specific program.

Skills : Customer Service, Pharmacy Claims, Healthcare, Contact Center, Medical Claims Adjudication Experience : Experienced2 year(s)

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qualifications : Experience

Education

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