Claims Specialist
Claims Specialist
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Our Company
PharMerica
Overview
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
Responsibilities
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
Qualifications
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
About our Line of Business
Additional Job Information
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.
Salary Range
Required Experience:
Unclear Seniority
Employment Type
Full-Time
