Pharmacy Claims Processor / Remote
About The Position
PharMerica is hiring a Pharmacy Claims Processor (also described as a Claims Specialist – 3rd Party) to manage pharmacy claims for long-term care and senior living clients. The position is part of a non-retail, closed-door pharmacy environment and is 100% remote. The role focuses on resolving rejected claims, supporting timely and accurate billing, and helping ensure maximum payer reimbursement while meeting critical deadlines. Varying shifts are available between 7:00 AM and 11:00 PM; night and weekend shifts are also available. The successful candidate will work with national Medicare Part D plans, third-party insurance companies, and state Medicaid plans. They will research and resolve claims, perform edits or reversals, monitor billing and payer processes, address revenue risks, and collaborate with the team to identify and resolve trends and issues. High school diploma or GED and customer service experience are required. Pharmacy technician experience or pharmaceutical knowledge is preferred, and pharmacy technician certification is desired but not required.
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.
- Knowledge of pharmaceuticals.
- Pharmacy technician license or certification (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 support timely billing.
- Research, analyze, and resolve rejected claims by working with Medicare Part D plans, third-party insurers, and state Medicaid plans while meeting deadlines.
- Perform appropriate claim edits and/or reversals to obtain claim approval and maximize reimbursement.
- Monitor and resolve revenue risks associated with payer setup, billing, rebilling, and reversals.
- 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, 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
Education Level
High school or GED
