Remote Pharmacy Claims Specialist

BrightSpring Health Services Corporation; Vancouver (WA); Remote; USD 29.000 - 32.000; Vollzeit

Benefits dieser Stelle

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

Zusammenfassung

PharMerica is seeking a Claims Specialist for 3rd party claims processing. This 100% remote role focuses on managing rejected pharmacy claims and maximizing payer reimbursement for long‑term care and senior living providers.

You will resolve claims with Medicare D plans, third party insurers, and state Medicaid while supporting timely billing and accurate financial records. Growth opportunities exist in a fast‑growing, non-retail environment.

Qualifikationen

• High School Diploma or GED is required.
• Associate’s or Bachelor’s degree is preferred.
• Customer Service experience is required.
• Pharmacy Technician experience is preferred.
• Knowledge of insurance industry trends and regulatory considerations is desirable.
• Pharmacy technician certification is preferred but not required.

Aufgaben

• 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 with Medicare D plans, third party insurers and state Medicaid.
• Ensures approval of claims by performing edits/reversals to maximize reimbursement.
• Monitors and resolves revenue at risk from payer setup, billing, rebilling and reversals.
• Collaborates with team to identify payer/billing trends and issues.
• Reviews and works to convert billing exception reports to ensure accurate billing.
• Prepares and maintains reports and records for processing.
• Performs other tasks as assigned.

Kenntnisse

Retention & recall

Fast-paced work

Basic math

Insurance trends

Ausbildung

High School Diploma/GED

Associate/Bachelor

Tools

Microsoft Office

Jobbeschreibung

PharMerica is seeking a Claims Specialist for 3rd party claims processing. This 100% remote role focuses on managing rejected pharmacy claims and maximizing payer reimbursement for long‑term care and senior living providers.

You will resolve claims with Medicare D plans, third party insurers, and state Medicaid while supporting timely billing and accurate financial records. Growth opportunities exist in a fast‑growing, non-retail environment.