Prior Approval Billing Specialist Job – Brockton MA 25472

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Why You'll Love This Job!
Apothecare Pharmacy LLC is looking for a Prior Approval Billing Specialist to join our finance team.
Apothecare is one of the region's largest independently owned long-term care pharmacy providers. With over a decade of serving the needs of group homes, assisted living and hospices facilities, we have grown to care for over 5,000 patients throughout the Commonwealth of Massachusetts. Additionally, our non-sterile compounding program is just one of three PCAB accredited programs in the state. Licensed in Massachusetts, Rhode Island, New Hampshire, Connecticut, and New Jersey, Apothecare has been growing rapidly and is looking to accelerate its growth in the region.  

Prior Approval Billing Specialist Responsibilities
  • Initiate Prior Approval medication claims based on a dynamic daily queue
  • Communicate with patients’ families and representatives to clarify the PA process and set proper expectations
  • Follow up with doctors’ offices and insurance companies regarding the status of PA claims
  • Monitor PA Inbox to ensure approved PA claims are processed timely
  • Communicate with doctor’s offices regarding denied claims to initiate alternative medication prescription or appeal of denied claims
  • Work on erroneous claims to reduce delays in the PA process
  • Complete PA processing timely to prevent billing of expensive medications to patients’ accounts and ensure proper billing to insurance
  • Maintain detailed records and notes of all PA processing steps and communications
  • Assist insurance billing team with resolution of pending insurance claims
  • Review high cost private charges and copays before posting to patients’ accounts
  • Establish and maintain good working relationships with customers and company staff
  • Maintain confidentiality of the patients’ medical information
  • Other duties as assigned          
Prior Approval Billing Specialist Qualifications
  • Prior experience as a billing specialist, preferably insurance or pharmacy billing
  • Basic computer and data entry skills
  • Strong attention to detail
  • Ability to work in a fast-paced environment and adhere to deadlines
  • Excellent oral and written communication skills
  • Outstanding customer service skills
  • Strong work ethic and ability to work well independently and as part of a team
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job number: 25472
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