What are the responsibilities and job description for the AR Claims Denial Clerk-Remote position at Orsini - Rare Disease Pharmacy Solutions?
About Orsini Specialty Pharmacy
Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.
Our Mission
Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.
LIVE IT Values
At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.
Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First
POSITION SUMMARY
Salary Range: $22-$25 Hourly
The Claims Denial Clerk is responsible obtaining status of claims once they age beyond a specified time range. The claims clerk will submit simple documentation requested by payors to get claims paid. The CDC will work with the Collection manager, billing team and auditor on denials that require a higher level of attention such as appeals, grievances rebills etc. The CDC will check and advise BV team when claims deny for eligibility issues. The claims denial clerk will assist with a any other duty assigned as needed.
REQUIRED KNOWLEDGE, SKILLS & TRAINING
- Minimum 1 year of experience in patient accounts, BV and/or collections preferably specialty pharmacy
- Familiar with AR and operational health care systems
- Experience with Microsoft applications. (Excel, Word, PowerPoint, etc)
- Familiar with medical terminology
- Experience with billing
- Able to multitask and utilize excel in a fast-paced working environment
- Able to problem solve and assist coworkers through the thought process of solving problems
- Collaborate on best practices for efficiency and streamlines communication throughout teams
ESSENTIAL JOB DUTIES
- Provide claim status on outstanding claims
- Research denials takes necessary action to resolve requests
- Utilizes the most efficient resources to resolve denials quickly
- Identifies short payments, over payments, unpaid claims, and resolves accordingly. Reviews residual balances after payments are applied and generates necessary adjustments, overpayment notification, refund requests
- Work with copay assistance plan to obtain eligibility to determine if patient was active during the DOS that we are billing
- Work with copay assistance plan to confirm that funds are still available initiate transfer
- Communicate with the PCC Team when patients are no longer active with the copay assistance plan
- Ability to work remotely
- Ability to be flexible and assist with other projects when needed.
EMPLOYEE BENEFITS
- BCBSL Medical
- Delta Dental
- EyeMed Vision
- 401k
- Accident & Critical Illness
- Life Insurance
- PTO, Holiday Pay, and Floating Holidays
- Tuition Reimbursement
Salary : $22 - $25
