Pharmacy Claims Processor / Remote

Amerita, Inc; Louisville (KY); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Shift differentials

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Tuition assistance

Employee discounts

401k

Job summary

Amerita, a pharmacist-focused company, seeks a Claims Specialist to support long-term care and senior living clients in a 100% remote role. You will leverage pharmacy claims experience to manage rejected claims, partner with Medicare D, Medicaid and insurers, and ensure timely, accurate reimbursements while delivering high-quality service.

The position emphasizes strong attention to detail, customer service, and compliance in a fast-paced environment, with a non-retail, closed-door setting and

Qualifications

• Required: High School Diploma or GED
• Desired: Associate’s or Bachelor’s Degree
• Required: Customer Service
• Desired: Pharmacy Technician experience
• Required: Ability to retain a large amount of information and apply that knowledge to related situations
• Desired: Knowledge of insurance industry trends

Responsibilities

• Manages a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing
• Researches, analyzes and resolves rejected claims with national Medicare D plans, third party insurers and Medicaid
• Ensures approval of claims by edits and reversals for maximum reimbursement
• Monitors and resolves revenue related to payer setup, billing, rebilling and reversal processes
• Identifies and resolves payer/billing trends and issues
• Converts billing exception reports to ensure claims are billed to correct financial plans
• Prepares and maintains processing reports and records
• Performs other tasks as assigned

Skills

Pharmacy claims

Customer service

Microsoft Office

Fast-paced

Education

High school diploma or GED

Associates or Bachelor’s degree

Job description

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.

Our Company

Amerita

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.

Shift:

Nights & Weekends

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

Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com . Follow us on Facebook , LinkedIn , and X .

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.