Claims Specialist / 3rd Party

PharMerica•Vancouver, WA

10d•$21 - $23•Remote

About The Position

PharMerica is hiring a Claims Specialist - 3rd Party to manage rejected pharmacy claims in a non-retail, closed-door pharmacy environment. The role focuses on securing maximum payer reimbursement, maintaining timely billing, and resolving claims for long-term care and senior living clients. This is a 100% remote position with flexible schedules and competitive pay with shift differentials. The Claims Specialist works with national Medicare D plans, third-party insurance companies, and state Medicaid plans. The position also involves reviewing billing exceptions, monitoring revenue risks, preparing reports, and collaborating with teammates to identify and resolve payer and billing trends. This is an opportunity to move from a retail to an office environment and learn claims, billing, and insurance processing. PharMerica, an affiliate of BrightSpring Health Services, provides pharmacy care through local teams and a national network, serving skilled nursing facilities, senior living communities, hospitals, and other care settings.

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; 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.
Research, analyze, and resolve rejected claims with Medicare Part D plans, third-party insurance companies, and state Medicaid plans while meeting critical deadlines.
Perform appropriate edits and reversals to secure claim approval 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 ensure claims are billed to accurate financial plans.
Prepare and maintain processing reports and records.
Perform other tasks as assigned.