LTC Pharmacy Claims Specialist / Remote

Job Description

Job Description

Overview

Step Into a Rewarding Role as an LTC Pharmacy 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.

Shift: Varying shifts available from 4:30am-12:00am. Overnight & Weekend shifts required.

Must have pharmacy claims or adjudication background.

What We Offer:

• DailyPay
• Flexible Schedules
• Competitive Pay with Shift Differentials
• Health, Dental, Vision, and Life Insurance
• Company-Paid Disability Insurance
• Tuition Assistance & Reimbursement
• Employee Discount Program
• 401k Plan
• Paid Time Off
• Non-Retail, Closed-Door Environment

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 risks
• Researches, 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 deadlines
• Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes
• Works as a team to identify, document, communicate and resolve payer/billing trends and issues
• Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans
• Prepares and maintains reports and records for processing
• Performs other tasks as assigned

Qualifications

Education/Learning Experience:

• Required: High School Diploma or GED
• Desired: Associate’s or Bachelor’s Degree

Work Experience:

• Required: Customer Service
• Desired: Up to one year of related experience. Pharmacy Technician experience

Skills/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 Suite
• Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters

Licenses/Certifications:

• Desired: Pharmacy technician, but not required