Pharmacy Claims Processor / Remote

PharMerica; United States; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Shift differentials

Health insurance

Dental insurance

Vision insurance

Life insurance

Tuition assistance & reimbursement

401k plan

Paid time off

Non-retail, closed-door environment

Job summary

PharMerica is seeking a Claims Specialist to support our long-term care and senior living clients in a 100% remote role across the United States. You will manage and resolve pharmacy claims, collaborate with payers, and help ensure accurate reimbursement and timely billing.

The ideal candidate has pharmacy claims experience, solid customer service skills, and proficiency in Microsoft Office. A high school credential is required, with preferred associate or bachelor’s degrees.

Qualifications

• Pharmacy claims experience and customer service skills are essential.
• Ability to analyze and resolve rejected claims under deadlines is required.
• Familiarity with Medicare/Medicaid and third-party payers is advantageous.

Responsibilities

• Manage and resolve a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing.
• Research and analyze rejected claims with national Medicare D plans, third-party insurers and state Medicaid programs.
• Ensure claims approvals by applying edits and reversals to maximize reimbursement and minimize financial risk.
• Monitor payer set up, billing, rebilling and reversal processes to recover at-risk revenue.

Skills

Pharmacy claims experience

Customer service

Attention to detail

Microsoft Office

Education

High School Diploma or GED

Associate's or Bachelor's Degree

Tools

Microsoft Office Suite

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.