Claims Specialist / 3rd Party
About The Position
PharMerica is hiring a Claims Specialist - 3rd Party to manage rejected pharmacy claims and help ensure maximum payer reimbursement and timely billing. The role supports long-term care and senior living clients in a non-retail, closed-door pharmacy environment. It is 100% remote and involves working with Medicare Part D plans, third-party insurance companies, and state Medicaid plans to research, analyze, and resolve claims while meeting critical deadlines. The position also monitors billing and payer processes, helps identify and resolve trends and issues, and maintains processing reports and records.
Requirements
- High school diploma or GED.
- Customer service experience.
- Ability to retain a large amount of information and apply it to related situations.
- Ability to work in a fast-paced environment.
- Basic math aptitude.
- Microsoft Office Suite skills.
Nice To Haves
- Associate’s or bachelor’s degree.
- Up to one year of related experience.
- Pharmacy technician experience or knowledge of pharmaceuticals.
- Pharmacy technician certification or license; it is preferred but not required.
- Knowledge of insurance industry trends, directions, major issues, regulatory considerations, and trendsetters.
Responsibilities
- Manage and identify a portfolio of rejected pharmacy claims to maximize payer reimbursement and ensure timely billing while reducing financial risks.
- Research, analyze, and resolve rejected claims by working with Medicare Part D plans, third-party insurance companies, and state Medicaid plans, adhering to critical deadlines.
- Perform appropriate edits and reversals to obtain claim approvals and maximize payer reimbursement.
- Monitor and resolve at-risk revenue related to payer setup, billing, rebilling, and reversal processes.
- Work with the team to identify, document, communicate, and resolve payer and billing trends and issues.
- Review billing exception reports and work to convert exceptions so claims are billed to accurate financial plans.
- Prepare and maintain processing reports and records.
- Perform other tasks as assigned.
Benefits
- DailyPay
- Flexible schedules
- Competitive pay with shift differentials
- Health, dental, vision, and life insurance
- Company-paid disability insurance
- Tuition assistance and reimbursement
- Employee discount program
- 401(k) plan
- Paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
