Florida Licensed Part D Claims Specialist
Job Summary
To support the Part D plan, the full-time Florida Licensed Part D Claims Specialist will manage and reconcile Part A claims, ensure compliance with CMS regulations, and collaborate with various specialists while working remotely.
Key responsibilities
- Reconcile and manage Part A claims and stays, ensuring proper billing to Part D
- Perform compliance tasks related to Part D, including reviewing CMS reports and managing rejected claims
- Download, analyze, and report on Part D and PBM data, coordinating with Medicare and Medicaid specialists as needed
Required qualifications
- 3+ years of experience working with medical and/or pharmacy claims
- Current advanced knowledge of medication names, dosages, and administration routes
- Experience navigating EMR systems and interpreting EMR data
- Advanced Excel skills for managing large data volumes, including formulas and pivot tables
- Associate's degree or formal training beyond high school in lieu of an Associate's degree
Complete Job Description
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