Claims Specialist / Remote

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. What You’ll Do: 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 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 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: 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. Additional Job Information This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing. Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference. #J-18808-Ljbffr BrightSpring Health Services