ABOUT ORSINIProviding 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 MISSIONOrsini 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™. CORE VALUESAt 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.COMPENSATION & LOCATIONThe salary range for this role is $25This position is remote but may require some travel to attend meetings and events.POSITION SUMMARYThe Pharmacy Claims Specialist is responsible for adjudicating pharmacy claims, monitoring workflow queues, reviewing billing accuracy, and resolving rejected claims to ensure timely and accurate processing. This role requires strong attention to detail, analytical skills, and knowledge of pharmacy claims processing systems to support efficient reimbursement and compliance with payer requirements.ESSENTIAL DUTIESClaims Adjudication and Processing: Verifying and processing pharmacy claims to ensure they are accurate, complete, and compliant with insurance policies.Resolving Claim Rejections: Investigating and resolving discrepancies in claims, such as prescription errors, eligibility issues and entering claim overrides.Collaboration: Coordinating with insurance companies to resolve claim issues and ensure timely processingBilling Review and Compliance: Review pharmacy billing data for accuracy and resolve discrepancies before claim submission.Coordinate with other departments (e.g., therapy teams, contracting, finance) to ensure alignment of processes and efficiency in claim resolution.Ensure compliance with federal, state, and local regulations, as well as company policies, including healthcare regulations (e.g., HIPAA, Medicaid, Medicare, ACA).Other duties and responsibilities as required. Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description. KNOWLEDGE, SKILLS, AND TRAININGAt least 1 year experience within Specialty Pharmacy operations settingProficiency with pharmacy claims processing systems, CareTend preferredAttention to Detail: High level of accuracy in reviewing claims to avoid errorsCommunication Skills: Ability to communicate effectively with healthcare providers, insurance representatives, to resolve claims-related issues.Strong analytical and problem-solving skillsStrong understanding of healthcare regulations, including HIPAA, Medicare, and ACA requirementsDetailed-oriented with strong organizational skillsPharmacy Technician License preferredEMPLOYEE BENEFITSWe offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:Medical Coverage, Dental, and Vision Coverage401(k) with employer matchAccident and Critical Illness coverageCompany-paid life insurance optionsGenerous PTO, paid holidays, and floating holidaysTuition reimbursement program.
