Job Description
Job Description
Overview
Step Into a Rewarding Role as a Claims Specialist with PharMerica!
Are you ready to make a real impact in a growing organization? Join our PharMerica team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters—delivering exceptional care and service.
Why Join PharMerica?
- Focused on Service Excellence : Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation.
- Career Growth : We’re in high growth mode, offering plenty of opportunities for those looking to advance their careers.
- Remote Flexibility : This position is 100% remote, giving you the freedom to work from anywhere!
What You’ll Do : As a dynamic Claims Specialist, you will :
Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need.Be a vital part of a team that’s dedicated to enhancing patient care through meticulous claims management and customer service.What We Offer :
DailyPayFlexible SchedulesCompetitive Pay with Shift DifferentialsHealth, Dental, Vision, and Life InsuranceCompany-Paid Disability InsuranceTuition Assistance & ReimbursementEmployee Discount Program401k PlanPaid Time OffNon-Retail, Closed-Door EnvironmentIf you’re passionate about service excellence and are looking for a role where you can grow and make a difference, we’d love to have you on our team. Apply today and start a fulfilling career with PharMerica!
Note : This position will be posted for a minimum of 7 business days.
Responsibilities
The Claims Specialist - 3rd Party :
Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risksResearches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlinesEnsures approval of claims by performing appropriate edits and / or reversals to ensure maximum payer reimbursementMonitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processesWorks as a team to identify, document, communicate and resolve payer / billing trends and issuesReviews and works to convert billing exception reports to ensure claims are billed to accurate financial plansPrepares and maintains reports and records for processingPerforms other tasks as assignedQualifications
Education / Learning Experience :
Required : High School Diploma or GEDDesired : Associate’s or Bachelor’s DegreeWork Experience :
Required : Customer ServiceDesired : Up to one year of related experience. Pharmacy Technician experienceSkills / Knowledge :
Required : Ability to retain a large amount of information and apply that knowledge to related situations. Ability to work in a fast-paced environment. Basic math aptitude. Microsoft Office SuiteDesired : Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsettersLicenses / Certifications :
Desired : Pharmacy technician, but not required
