Pharmacy Claims Processor / Remote

PharMerica•Lyndon, KY

3d•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 and helps ensure timely, accurate billing and maximum payer reimbursement. It is 100% remote, with varying shifts available between 7:00 AM and 11:00 PM; nights and weekends are also available. The position is an opportunity to move from a retail to an office environment while learning claims, billing, and insurance processing. The successful candidate will work with Medicare Part D plans, third-party insurers, and state Medicaid plans, and collaborate with teammates to address payer and billing issues. PharMerica is an affiliate of BrightSpring Health Services and provides pharmacy services to health care providers and individuals across the nation.

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; a pharmacy technician license or certification is preferred but not required.
Knowledge of pharmaceuticals.
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 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.