Claims Specialist

PharMerica

Step Into a Rewarding Role as a Claims Specialist with PharMerica!

Are you ready to make a real impact in a growing organization Join our PharMerica team as a Claims Specialist where youll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail closed-door pharmacy environment allowing you to focus on what truly mattersdelivering exceptional care and service.

This is a remote opportunity. Applicants can reside anywhere within the Continental USA.

Schedule: Monday - Friday 9-5 EST

Why Join PharMerica

• Focused on Service Excellence: Our mission is to provide top-quality care and outstanding customer service to hospitals rehabilitation centers long-term acute care hospitals and specialized care centers across the nation.
• Career Growth: Were in high growth mode offering plenty of opportunities for those looking to advance their careers.
• Remote Flexibility: This position is 100% remote giving you the freedom to work from anywhere!

What Youll Do: As a dynamic Claims Specialist you will:

• Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently ensuring our clients get the support they need.
• Be a vital part of a team thats dedicated to enhancing patient care through meticulous claims management and customer service.
• Pharmacy Technician experience preferred

What We Offer:

• DailyPay
• Flexible Schedules
• Competitive Pay with Shift Differentials
• Health Dental Vision and Life Insurance
• Company-Paid Disability Insurance
• Tuition Assistance & Reimbursement
• Employee Discount Program
• 401k Plan
• Paid Time Off
• Non-Retail Closed-Door Environment

The Claims Specialist - 3rd Party:

• Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
• Researches analyzes and appropriately resolves rejected claims by working with national Medicare D plans third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
• Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Monitors and resolves at risk revenue associated with payer set up billing rebilling and reversal processes
• Works as a team to identify document communicate and resolve payer/billing trends and issues
• Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans
• Prepares and maintains reports and records for processing
• Performs other tasks as assigned

Education/Learning Experience:

• Required: High School Diploma or GED
• Desired: Associates or Bachelors Degree

Work Experience:

• Required: Customer Service
• Desired: Up to one year of related experience. Pharmacy Technician experience

Skills/Knowledge:

• Required: Ability to retain a large amount of information and apply that knowledge to related situations. Ability to work in a fast-paced environment. Basic math aptitude. Microsoft Office Suite
• Desired: Knowledge of the insurance industrys trends directions major issues regulatory considerations and trendsetters

Licenses/Certifications:

• Desired: Pharmacy technician but not required

This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims billing and insurance processing.

Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.