Pharmacy Claims Processor / Remote

BrightSpring Health Services•Louisville, KY

2d•Remote

About The Position

PharMerica is hiring a Claims Specialist - 3rd Party to manage and resolve rejected pharmacy claims for its long-term care and senior living clients. This role works in a non-retail, closed-door pharmacy environment and is 100% remote. The position focuses on maximizing payer reimbursement, ensuring timely and accurate billing, and supporting patient care through careful claims management and customer service. It may suit someone moving from a retail pharmacy setting to an office environment and willing to learn 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 or knowledge of pharmaceuticals; pharmacy technician experience and/or pharmaceutical knowledge is strongly preferred.
Pharmacy technician certification or license (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 while reducing 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 reversals to obtain claim approvals and maximize payer reimbursement.
Monitor and resolve revenue at risk 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.