Claims Processing Specialist - Hybrid (Elk Grove Village, IL)

<sup>About Orsini Rare Disease Pharmacy Solutions 

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

Salary Range: $20-$25 Hourly Based on Experience 

Position Summary
The 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.

Required Knowledge, Skills & Training</sup> 

• ^{At least 1 year experience within Specialty Pharmacy operations setting}
• ^{Proficiency with pharmacy claims processing systems, CareTend preferred}
• ^{Attention to Detail: High level of accuracy in reviewing claims to avoid errors}
• ^{Communication Skills: Ability to communicate effectively with healthcare providers, insurance representatives, to resolve claims-related issues}
• ^{Strong analytical and problem-solving skills}
• ^{Strong understanding of healthcare regulations, including HIPAA, Medicare, and ACA requirements}
• ^{Detailed-oriented with strong organizational skills}
• ^{Pharmacy Technician License preferred}

^{Essential Job Duties} 

• ^{Claims 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 processing}
• ^{Billing 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).}

^{Employee Benefits} 

• ^{BCBSL Medical}
• ^{Delta Dental}
• ^{EyeMed Vision}
• ^401k
• ^{Accident & Critical Illness}
• ^{Life Insurance}
• ^{PTO, Holiday Pay, and Floating Holidays}
• ^{Tuition Reimbursement}