Medical A/R Collector (Pharmacy Benefit Management)

Job Title: Medical A/R Collector (Pharmacy Benefit Management)

Job Overview:

We are seeking a detail-oriented Medical A/R Collector to join our team and contribute to the success of our Pharmacy Benefit Management (PBM) program. In this role, you will be responsible for managing and resolving PBM A/R issues while ensuring that all filing guidelines and appeals processes are met. This position requires a keen eye for detail and the ability to navigate complex accounts receivable issues in a timely manner.

Key Responsibilities:

• Resolve PBM accounts receivable issues, including claim rejections due to prior authorization, eligibility, coverage determination, and financial risk.
• Manage the retroactive authorization process, including responding to deferrals and handling delegated appeals.
• Process claims through various channels, including mail, online portals, and electronic billing adjudication systems.

Qualifications:

• Minimum of 2 years of experience as a pharmacy or medical biller and/or collector.
• Strong knowledge of PBM operations, A/R management, and claims processes.
• Familiarity with proper billing and CMS guidelines.

Schedule:

• Monday to Friday, 8:00 AM - 5:00 PM
• Hybrid work schedule (mix of in-office and remote work)

Location: Irvine, CA 92614

Pay: $25-$27 per hour

If you are an experienced professional with a solid understanding of PBM A/R management, we encourage you to apply for this opportunity to make an impact within a dynamic team.