Remote Pharmacy Claims Specialist - Reimbursement Expert

Haven Hospice; Louisville (KY); Remote; USD 48,000 - 64,000; Full time

Benefits offered by this job

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti；

Job summary

PharMerica is seeking a Claims Specialist to manage 3rd party pharmacy claims for our long-term care and senior living clients in a remote role. You will leverage your pharmacy claims experience to resolve rejected claims, work with national Medicare D plans and Medicaid, and help maximize payer reimbursement while meeting deadlines.

This role emphasizes accuracy, teamwork and customer service in a closed-door environment with flexible schedules and competitive pay.

Qualifications

• Education/learning: High School Diploma or GED required; Associate’s or Bachelor’s degree preferred.
• Work experience: Customer Service experience required; Pharmacy Technician experience preferred.
• Skills/Knowledge: Ability to retain lots of information, work in a fast-paced environment, basic math, and MS Office.

Responsibilities

• Manages a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing.
• Researches and resolves rejected claims with national Medicare D plans, third-party insurers and state Medicaid plans.
• Ensures claim approvals by applying edits and reversals to maximize reimbursement.
• Monitors revenue at risk from payer setup, billing, rebilling and reversal processes.
• Collaborates with the team to identify payer/billing trends and issues.
• Prepares and maintains processing reports and records.

Job description

PharMerica is seeking a Claims Specialist to manage 3rd party pharmacy claims for our long-term care and senior living clients in a remote role. You will leverage your pharmacy claims experience to resolve rejected claims, work with national Medicare D plans and Medicaid, and help maximize payer reimbursement while meeting deadlines.

This role emphasizes accuracy, teamwork and customer service in a closed-door environment with flexible schedules and competitive pay.