Pharmacy Claims Processor / Remote
About The Position
PharMerica is hiring a Claims Specialist - 3rd Party to manage and resolve rejected pharmacy claims in a non-retail, closed-door pharmacy environment. The role supports long-term care and senior living clients by helping ensure timely, accurate billing and maximum payer reimbursement. This position is 100% remote and involves working with Medicare Part D plans, third-party insurance companies, and state Medicaid plans. PharMerica is an affiliate of BrightSpring Health Services and provides pharmacy services to skilled nursing facilities, senior living communities, hospitals, and people with behavioral, infusion therapy, cancer-care, and in-home care needs. Its services include long-term care, home infusion, and specialty pharmacy solutions.
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 the insurance industry’s trends, directions, major issues, regulatory considerations, and trendsetters.
- Pharmacy technician certification or licensure; it is preferred but not required.
- Knowledge of pharmaceuticals.
Responsibilities
- Manage and identify a portfolio of rejected pharmacy claims to maximize payer reimbursement and ensure timely billing while minimizing 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 secure claim approvals and maximize payer reimbursement.
- Monitor and resolve at-risk revenue associated with 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, 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
Career Level
Entry Level
Education Level
High school or GED
