Pharmacy Claims Processor / Remote

Pharmerica; Louisville (KY); Remote; USD 42,000 - 66,000; Full time

Benefits offered by this job

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti

Health, Dental, Vision, Life Insurance

Company-Paid Disability Insurance

Tuition Assistance & Reimbursement

Employee Discount Program

401k Plan

Paid Time Off

Non-Retail, Closed-Door Environment

Job summary

PharMerica, an affiliate of BrightSpring Health Services, is seeking a Claims Specialist to manage 3rd party claims and optimize payer reimbursements in a 100% remote role. You will work with national Medicare D plans, insurance companies, and state Medicaid programs to ensure timely and accurate billing.

Join a growing team focused on delivering exceptional pharmaceutical support to long-term care and senior living clients, with strong benefits and a non-retail environment.

Qualifications

• Experience handling pharmacy claims and customer service in a healthcare setting.
• Familiarity with insurance plans and payer processes is a plus.
• Proficient with MS Office and ability to manage information efficiently.

Responsibilities

• Manages portfolio of rejected pharmacy claims to maximize reimbursement.
• Researches and resolves rejected claims with Medicare D, third-party, and Medicaid plans.
• Ensures claims approval by applying edits and reversals for maximum reimbursement.
• Monitors revenue at risk related to payer setup, billing, rebilling, and reversals.
• Collaborates to identify payer/billing trends and issues.
• Converts billing exception reports to accurate financial plans.
• Prepares and maintains processing reports and records.
• Performs other tasks as assigned.

Skills

Pharmacy claims

Customer service

Microsoft Office

Basic math

Fast-paced

Education

High School Diploma or GED

Associate/Bachelor's degree

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 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.

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: 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 that’s dedicated to enhancing patient care through meticulous claims management and customer service.

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: 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, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

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.