Remote Pharmacy Claims Specialist - Reimbursement Expert

BrightSpring Health Services; Louisville (KY); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Shift differentials

Health insurance

Dental insurance

Vision insurance

Life Insurance

Tuition assistance

Disability insurance

Employee discounts

401k

Paid time off

Closed-door environment

Job summary

PharMerica is seeking a Claims Specialist to support long-term care and senior living clients in a 100% remote role. You will leverage pharmacy claims experience to manage and resolve claims, ensuring timely reimbursement while upholding service excellence.

The role emphasizes accuracy, cross-checking payer requirements and working with Medicare plans and Medicaid to maximize payments. A strong customer-service background is essential for success.

Qualifications

• High School Diploma or GED is required.
• Associate's or Bachelor's Degree is desired.
• Pharmacy technician certification is a plus.

Responsibilities

• Manages and identifies a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing.
• Researches, analyzes and resolves rejected claims with Medicare D plans, third party insurers and Medicaid to ensure payment.
• Ensures approval of claims by performing edits and reversals to optimize reimbursement.
• Monitors revenue at risk from payer setup, billing, rebilling and reversal processes.
• Collaborates with team to document and resolve payer/billing trends.
• Reviews reports to ensure claims are billed to correct financial plans.
• Prepares and maintains processing reports and records.

Skills

Pharmacy claims experience

Customer service

Microsoft Office

Education

High School Diploma or GED

Associate's or Bachelor's Degree

Tools

Microsoft Office Suite

Job description

PharMerica is seeking a Claims Specialist to support long-term care and senior living clients in a 100% remote role. You will leverage pharmacy claims experience to manage and resolve claims, ensuring timely reimbursement while upholding service excellence.

The role emphasizes accuracy, cross-checking payer requirements and working with Medicare plans and Medicaid to maximize payments. A strong customer-service background is essential for success.