Remote Pharmacy Claims Specialist - 3rd Party

Brightspring Home Health - Pensacola; Louisville (KY); Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Comp pay with shift differentials

Healthcare benefits

Disability insurance

Tuition assistance

Employee discount program

401k Plan

Paid time off

Closed-door environment

Job summary

PharMerica, a non-retail, closed-door pharmacy, is seeking a Claims Specialist to support long-term care and senior living clients. This 100% remote role focuses on delivering accurate claims processing and exceptional service.

You will leverage pharmacy claims experience to manage rejected claims, work with Medicare D, Medicaid, and insurers, and help ensure timely reimbursements while upholding regulatory standards.

Qualifications

• High School Diploma or GED required.
• Associate's or Bachelor's Degree preferred.
• Customer Service experience required.
• Pharmacy Technician experience preferred.
• Knowledge of insurance/payer processes helpful.

Responsibilities

• Manages rejected pharmacy claims to maximize reimbursement.
• Resolves claims with Medicare/Medicaid and insurers.
• Ensures claim approval via edits/reversals.
• Monitors revenue at risk due to payer setup and rebilling.
• Prepares and maintains processing reports.

Skills

Retain information

Fast-paced

Basic math

Microsoft Office

Customer Service

Pharmacy knowledge

Education

High School Diploma

Associate's Degree

Bachelor's Degree

Job description

PharMerica, a non-retail, closed-door pharmacy, is seeking a Claims Specialist to support long-term care and senior living clients. This 100% remote role focuses on delivering accurate claims processing and exceptional service.

You will leverage pharmacy claims experience to manage rejected claims, work with Medicare D, Medicaid, and insurers, and help ensure timely reimbursements while upholding regulatory standards.