Pharmacy Claims Processor / Remote

BrightSpring Health Services•Louisville, KY

1d•Remote

About The Position

PharMerica is seeking a Claims Specialist to manage and resolve rejected pharmacy claims for its long-term care and senior living clients. This is a 100% remote role in a non-retail, closed-door pharmacy environment. The position focuses on maximizing payer reimbursement, ensuring timely and accurate billing, and supporting patient care through careful claims management and customer service. It is an opportunity to move from a retail to an office environment while learning 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.
Microsoft Office Suite skills.

Nice To Haves

Associate’s or bachelor’s degree.
Up to one year of related experience.
Pharmacy technician experience and/or knowledge of pharmaceuticals.
Pharmacy technician certification or licensure; 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 claim edits and 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 and convert billing exception reports to ensure claims are billed to accurate financial plans.
Prepare and maintain processing reports and records.
Perform other tasks as assigned.