Pharmacy Claims Processor / Remote
PharMerica
Summary
Step Into a Rewarding Role as a Claims Specialist with PharMerica! 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 matters—delivering exceptional care and service.
Job description
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.
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.
Requirements
- High School Diploma or GED
- Customer Service experience
- Pharmacy claims or adjudication background
- 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
Benefits
- DailyPay
- Flexible Schedules
- Competitive Pay
- Shift Differentials
- Health, Dental, Vision Insurance
- Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
Company overview
PharMerica is a leading national provider of institutional pharmacy services, specializing in comprehensive pharmacy management for long-term care settings. Headquartered in Louisville, Kentucky, the company operates over 180 long-term care pharmacies across nearly every state in the U.S., serving more than 3,100 facilities including skilled nursing facilities, senior living communities, behavioral health settings, and post-acute care facilities. With approximately 6,000 dedicated employees and over 30 years of industry experience, PharMerica delivers medication management services, cost containment solutions, compliance support, and clinical programs designed to improve patient outcomes while controlling healthcare costs. The company provides 24/7 medication availability, on-site IV services, consultant pharmacist reviews, and advanced technology platforms for medication ordering and management. As part of BrightSpring Health Services, PharMerica combines national scale with local expertise to offer personalized pharmacy solutions that go beyond traditional medication dispensing, focusing on helping people live their best lives through superior pharmacy care and support services.