Claims Specialist

Location: Tarentum, PADepartment: Claims DepartmentAt Blackburn's Physicians Pharmacy, our mission is simple: People first, Be kind, & Work together, for our patients, our employees, and our community. We are seeking a detail-oriented and motivated Claims Processing Specialist to join our growing Claims Department and help ensure timely, accurate, and compliant insurance claim processing for the patients we serve.This role is ideal for someone who thrives in a fast-paced healthcare environment and has experience with medical billing, insurance authorizations, claims follow-up, or healthcare documentation.Position SummaryThe Claims Processing Specialist is responsible for managing third-party medical claims, insurance documentation, and reauthorization processes to support uninterrupted patient care and timely reimbursement. This position plays a key role in reducing denials, maintaining compliance, and supporting operational efficiency across the claims process.Success in this role requires strong organizational skills, attention to detail, effective communication, and the ability to manage multiple priorities while meeting strict filing deadlines.Key ResponsibilitiesProcess and review third-party medical claims for accuracy, completeness, and complianceManage insurance documentation, authorizations, and requalification requirementsVerify benefits, authorization requirements, and payer guidelines for various insurance plansCreate, submit, monitor, and track documentation and authorization requests in a timely mannerFollow up on prescription renewals and required documentation to avoid delays in patient careWork collaboratively with internal departments, providers, patients, and insurance payers to resolve claim issues and denialsUtilize reporting tools and work queues to prioritize follow-up and maintain productivityIdentify trends impacting reimbursement or claims processing and communicate findings to managementAssist with denial resolution and process improvement initiatives to increase efficiency and reduce write-offsMaintain accurate records and ensure all documentation is audit-readySupport additional departmental projects and responsibilities as assignedWhat We OfferMeaningful work that directly supports patients receiving essential healthcare equipment and servicesA collaborative and supportive team environmentOpportunities for ongoing training, professional development, and career growthCompetitive compensation and benefitsA mission-driven workplace where your contributions make a real difference every dayQualificationsStrong attention to detail with excellent organizational and time-management skillsEffective written and verbal communication abilitiesAbility to manage multiple tasks and work efficiently in a deadline-driven environmentStrong interpersonal skills and ability to collaborate across teamsProficient computer and data-entry skillsExperience in healthcare, medical billing, DME/HME, or insurance claims processing preferredKnowledge of medical third-party billing and insurance authorization processes preferredFamiliarity with Medicare, Medicaid, and commercial insurance plans is a plusMicrosoft Word and Excel experience preferred