Claims Specialist / Remote
About The Position
Our Company PharMerica Overview Step Into a Rewarding Role as a Claims Specialist with PharMerica! Are you ready to make a real impact in a growing organization? Join our PharMerica team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters—delivering exceptional care and service. Why Join PharMerica? Focused on Service Excellence : Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation. Career Growth : We’re in high growth mode, offering plenty of opportunities for those looking to advance their careers. Remote Flexibility : This position is 100% remote, giving you the freedom to work from anywhere! What You’ll Do: As a dynamic Claims Specialist, you will: Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need. Be a vital part of a team that’s dedicated to enhancing patient care through meticulous claims management and customer service. Shift: Varying shifts available from 4:30am-12:00am
Requirements
- High School Diploma or GED
- Customer Service
- Ability to retain a large amount of information and apply that knowledge to related situations.
- Ability to work in a fast-paced environment.
- Basic math aptitude.
- Microsoft Office Suite
Nice To Haves
- Associate’s or Bachelor’s Degree
- Up to one year of related experience.
- Pharmacy Technician experience
- Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters
- Pharmacy technician, but not required
- Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.
Responsibilities
- Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
- Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
- Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
- Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes
- Works as a team to identify, document, communicate and resolve payer/billing trends and issues
- Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans
- Prepares and maintains reports and records for processing
- Performs 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 & Reimbursement
- Employee Discount Program
- 401k 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
