Pharmacy Claims Processor
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Job Description
Remote Pharmacy Claims Processor at PharMerica, managing rejected pharmacy claims and payer reimbursement. Supporting long-term care, senior living, and hospital pharmacy services.
Responsibilities:
- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing
- Research, analyze, and resolve rejected claims with Medicare D plans, third-party insurance companies, and state Medicaid plans
- Perform edits and/or reversals to obtain claim approval and maximize payer reimbursement
- Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes
- Identify, document, communicate, and resolve payer and billing trends and issues as part of a team
- Review and convert billing exception reports to ensure claims are billed to accurate financial plans
- Prepare and maintain processing reports and records
- Perform other assigned tasks
Requirements:
- High School Diploma or GED required
- Customer Service experience 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
- Associate’s or Bachelor’s Degree desired
- Up to one year of related experience desired
- Pharmacy Technician experience desired
- Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters desired
- Pharmacy technician certification desired but not required
Benefits:
- 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
- 100% remote work
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