Career | <?phpecho $jobTitle;?> | <?phpecho $companyName;?>

RCO-Advanced Claims Review Specialist


Somerset, NJ, US / Indianapolis, IN, US / Houston, TX, US / Lebanon, TN, US
  • Job Type: Full-Time
  • Function: Operations
  • Industry: Healthcare Services
  • Post Date: 05/25/2023
  • Website:
  • 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. We improve the accuracy, timeliness, accessibility, and efficiency of pharmacy services, consistently providing exemplary client service.

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 candidateresponsible 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 areessential.


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


EEO Statement:PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state or local law.EO/Minorities/Females/Disabled/Veterans


USD $17.50/Hr.


USD $19.50/Hr.