Remote Pharmacy Claims Specialist

BrightSpring Health Services; Louisville (KY); À distance; USD 30 000 - 39 000; Plein temps

Avantages offerts par ce poste

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti 

Health, Dental, Vision, and Life Ins.

Company-Paid Disability Insurance

Tuition Assistance & Reimbursement

Employee Discount Program

401k Plan

Paid Time Off

Non‑Retail, Closed‑Door Environment

Résumé du poste

PharMerica is seeking a Claims Specialist to support long‑term care and senior living clients with pharmacy claim processing and payer reimbursement. This 100% remote role emphasizes accuracy in claims handling and customer service excellence across national payer networks.

You will leverage pharmacy claims experience to resolve rejected claims, work with Medicare D plans and Medicaid, and contribute to process improvements within a non‑retail, closed‑door environment.

Qualifications

• Must have a High School Diploma or GED.
• Customer service experience required.
• Ability to retain large amounts of information and work in a fast-paced environment.
• Basic math aptitude and proficiency with Microsoft Office.

Responsabilités

• Manage and identify a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing.
• Research, analyze and resolve rejected claims with Medicare D plans, third‑party insurers and state Medicaid to ensure reimbursement.
• Ensure approvals by performing edits or reversals to maximize reimbursement.
• Monitor and resolve revenue at risk from payer setup, billing, rebilling and reversal processes.
• Communicate and resolve payer/billing trends and issues as a team.
• Convert billing exception reports to ensure claims bill to correct financial plans.
• Prepare and maintain processing reports and records.
• Perform other tasks as assigned.

Connaissances

Information retention

Fast-paced environment

Basic math

Microsoft Office

Formation

High School Diploma or GED

Associate or Bachelor’s Degree (desired)

Description du poste

PharMerica is seeking a Claims Specialist to support long‑term care and senior living clients with pharmacy claim processing and payer reimbursement. This 100% remote role emphasizes accuracy in claims handling and customer service excellence across national payer networks.

You will leverage pharmacy claims experience to resolve rejected claims, work with Medicare D plans and Medicaid, and contribute to process improvements within a non‑retail, closed‑door environment.