Get It Recruit – Healthcare Hiring for Medicare Claims Analyst – Remote | WFH at Aurora, CO Full Time

Are you passionate about ensuring seniors access the vital medications they need? Do you thrive in a collaborative environment, tackling challenges with a keen eye for detail? If so, we invite you to join our team as a Medicare Claims Analyst, playing a crucial role in our client’s Part D Prescription Drug Plan.

Responsibilities

In this dynamic role, you’ll work closely with Medicare, Medicaid, finance, and billing specialists to ensure accurate and timely processing of claims. You’ll delve into the world of pharmacy claims management, with responsibilities including:

Managing and reconciling Part A claims and stays: Maintaining patient eligibility and coordinating with providers for seamless care.

Ensuring accurate Part D billing: Applying CMS regulations and interpreting EMR data to guarantee appropriate billing.

Performing Part D compliance tasks: Navigating B vs D, ESRD, Medical Necessity, and other compliance areas.

Analyzing s and taking action: Downloading and reviewing PBM and CMS s, identifying and resolving discrepancies.

Building bridges: Communicating effectively with pharmacies, PBMs, and internal teams to resolve claim issues and maintain provider credentials.

Who We’re Looking For

A detail-oriented individual with 3+ years of experience in medical and/or pharmacy claims.

An Excel wizard with strong data analysis skills and comfort navigating healthcare EMRs.

A medication aficionado with knowledge of names, dosages, indications, and administration routes.

A patient advocate experienced in managing plan eligibility and familiar with PACE programs.

A master of regulations with a deep understanding of Medicare Part D requirements.

Beyond The Basics

You thrive in a fast-paced, multi-screen environment, juggling data with ease.

You conquer deadlines with a cool head and a solutions-oriented approach.

You relish working independently and collaborating effectively to achieve shared goals.

Your communication skills are top-notch, keeping everyone informed and on track.

More Than Just a Job

Join a team passionate about supporting patient access to vital medications. You’ll contribute to a positive, collaborative environment where your commitment and expertise are valued.

Employment Type: Full-Time