RCO-Advanced Claims Review Specialist


Somerset, NJ, US
  • Job Type: Full-Time
  • Function: Accounting/Finance
  • Post Date: 06/06/2021
  • Website: pharmscript.com
  • Company Address: 150 Pierce Street, Somerset, NJ, 08873

About PharmScript

PharmScript provides superior pharmacy services in support of long-term and post-acute care facilities.

Job Description

Job Description:

PharmScript is one of the nation’s leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 1,700 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most.


We’re looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department. As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. 


The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential.


Key Responsibilities:

  • Responsible for workflow- submitting retro re-billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner
  • Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior
  • Prioritize your work activities daily
  • Timely response to all customer inquiries, both inbound and outbound prior
  • Responsible for working with nursing facilities/customer service representative to review charges related insurance



  • High school degree
  • Must possess or be willing to apply for NJ Pharmacy Technician license
  • Previous experience working with Long-term care facilities preferred
  • Able to work independently as well as in a diverse, team environment
  • Reliable, able to work under pressure and meet deadlines
  • Excellent communication skills, professional demeanor
  • Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
  • Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances
  • Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items


Skills and Abilities:

  • Able to identify and resolve issues quickly and efficiently
  • Excellent communication, problem solving and organizational skills
  • Comfortable working independently as well as in a diverse, team environment
  • Able to work under pressure and meet deadlines
  • Strong customer service skills
  • Ability to lift and/or move up to 25 pounds
  • Strong analytical problem solving and strategic thinking skills
  • Excellent interpersonal skills
  • Basic computer skills and proficient in Microsoft Office
  • Moderate to advanced computer skills required
  • Ability to work at a moderate speed
  • Must possess strong telephone communication skills and etiquette
  • Detail oriented, excellent organizational skills

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.