Pharmacy Claims Processor / Remote

PharMerica•Lyndon, KY

2d•Remote

About The Position

PharMerica is hiring a Claims Specialist - 3rd Party to manage and resolve rejected pharmacy claims for its long-term care and senior living clients. The role supports maximum payer reimbursement and timely, accurate billing in a non-retail, closed-door pharmacy environment. This position is 100% remote and has a nights and weekends shift. It may be a fit for someone moving from a retail to an office environment who is willing to learn claims, billing, and insurance processing.

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.
Knowledge of 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 license or certification; not required.
Knowledge of pharmaceuticals.

Responsibilities

Manage and identify a portfolio of rejected pharmacy claims to maximize payer reimbursement and ensure timely billing while eliminating financial risks.
Research, analyze, and resolve rejected claims by working with national Medicare Part D plans, third-party insurance companies, and state Medicaid plans while meeting critical deadlines.
Perform appropriate edits and/or reversals to obtain 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.