Pharmacy Claims Processor / Remote
About The Position
PharMerica is seeking a Claims Specialist to support pharmacy claims processing for long-term care and senior living clients. This is a 100% remote position in a non-retail, closed-door pharmacy environment, with a night and weekend shift. The role manages rejected pharmacy claims, works to secure maximum payer reimbursement, and supports timely and accurate billing. The position is an opportunity to move from a retail to an office environment while learning claims, billing, and insurance processing. PharMerica, an affiliate of BrightSpring Health Services, provides pharmacy services to skilled nursing facilities, senior living communities, hospitals, and other care settings. Its services include long-term care, home infusion, and specialty pharmacy, supported by technology and regulatory expertise.
Requirements
- High school diploma or GED.
- Customer service experience.
- Ability to retain and apply a large amount of information 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 licensure; desired 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.
- Research, analyze, and resolve rejected claims by working with Medicare Part D plans, third-party insurance companies, and state Medicaid plans, while meeting 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 them 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 insurance
- Dental insurance
- Vision insurance
- 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
Education Level
High school or GED
