Remote Pharmacist - Medicare Appeals & Case Review

A-Line Staffing Solutions; Woonsocket (RI); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

401(k) with company match

Benefits after 90 days

Job summary

A-Line Staffing Solutions seeks a pharmacist to support Medicare appeals processing remotely from anywhere in the US. The role focuses on case setup, clinical review, and documentation, with a requirement for an active pharmacist license in the state of residence.

Training occurs during the first 8-10 weeks with scheduled hours; post-training shifts may include weekends or longer hours. A dedicated home workspace and reliable internet are required.

Qualifications

• Active pharmacist license in the state of residence.
• Experience with data entry and navigation of multiple applications.
• Familiarity with outbound calls is a plus.
• Ability to work remotely with a dedicated home workspace.

Responsibilities

• Ensure accuracy of case setup and clinical review of Medicare appeals cases by reviewing internal notes or fax requests for pertinent information.
• Provide clear and concise documentation and contact providers to obtain clinical details for case decisions.
• Adhere to work instructions and Medicare guidelines to ensure proper case processing.
• Maintain compliance with CMS-mandated timelines and departmental productivity and quality standards.
• Apply clinical judgment using drug compendia resources, work instructions, and CMS Medicare guidance.
• Participate in development discussions and receive feedback from supervisors to support continuous improvement.

Skills

Active pharmacist license

Data entry

Microsoft Access

PowerPoint

Visio

Excel

Word

Outbound calls

Education

Bachelor's degree in pharmacy

Pharm D

Tools

Microsoft Access

PowerPoint

Visio

Excel

Word

Job description

A-Line Staffing Solutions seeks a pharmacist to support Medicare appeals processing remotely from anywhere in the US. The role focuses on case setup, clinical review, and documentation, with a requirement for an active pharmacist license in the state of residence.

Training occurs during the first 8-10 weeks with scheduled hours; post-training shifts may include weekends or longer hours. A dedicated home workspace and reliable internet are required.