Remote Pharmacy Claims Specialist — 3rd Party

BrightSpring Health Services Corporation; Louisville (KY); Remote; USD 42,000 - 66,000; Full time

Benefits offered by this job

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti

Health, Dental, Vision, Life Insurance

Company-Paid Disability Insurance

Tuition Assistance & Reimbursement

Employee Discount Program

401k Plan

Paid Time Off

Non-Retail, Closed-Door Environment

Job summary

PharMerica, an affiliate of BrightSpring Health Services, is seeking a Claims Specialist to manage 3rd party claims and optimize payer reimbursements in a 100% remote role. You will work with national Medicare D plans, insurance companies, and state Medicaid programs to ensure timely and accurate billing.

Join a growing team focused on delivering exceptional pharmaceutical support to long-term care and senior living clients, with strong benefits and a non-retail environment.

Qualifications

• Experience handling pharmacy claims and customer service in a healthcare setting.
• Familiarity with insurance plans and payer processes is a plus.
• Proficient with MS Office and ability to manage information efficiently.

Responsibilities

• Manages portfolio of rejected pharmacy claims to maximize reimbursement.
• Researches and resolves rejected claims with Medicare D, third-party, and Medicaid plans.
• Ensures claims approval by applying edits and reversals for maximum reimbursement.
• Monitors revenue at risk related to payer setup, billing, rebilling, and reversals.
• Collaborates to identify payer/billing trends and issues.
• Converts billing exception reports to accurate financial plans.
• Prepares and maintains processing reports and records.
• Performs other tasks as assigned.

Skills

Pharmacy claims

Customer service

Microsoft Office

Basic math

Fast-paced

Education

High School Diploma or GED

Associate/Bachelor's degree

Job description

PharMerica, an affiliate of BrightSpring Health Services, is seeking a Claims Specialist to manage 3rd party claims and optimize payer reimbursements in a 100% remote role. You will work with national Medicare D plans, insurance companies, and state Medicaid programs to ensure timely and accurate billing.

Join a growing team focused on delivering exceptional pharmaceutical support to long-term care and senior living clients, with strong benefits and a non-retail environment.