Claims Specialist

Claims Specialist

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 you'll 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 3 pm-11 pm Mountain time

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 : We're 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 You'll Do :

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 that's 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 :

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 : Associate's or Bachelor's 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 industry's trends, directions, major issues, regulatory considerations and trendsetters

Licenses / Certifications : Desired : Pharmacy technician, but not required

About our Line of Business : PharMerica, an affiliate of BrightSpring Health Services, is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations, and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies, offering unmatched company culture, employee development, and advancement opportunities.

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 : USD $19.00 - $25.00 / Hour