Claims Specialist / Remote

Responsibilities

• 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.
• 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.
• Sets up, bills, rebills, and reverses claims to ensure maximum payer reimbursement.
• Maintains accuracy and completeness of claims data.
• Monitors and resolves at-risk revenue associated with payer setup, billing, rebilling, and reversal processes.
• Identifies, documents, communicates, and resolves payer/billing trends and issues.
• Prepares and maintains reports and records for processing.
• Converts billing exception reports to ensure claims are billed to accurate financial plans.
• Performs other tasks as assigned.

Qualifications

• Required: High School Diploma or GED.
• Desired: Associate’s or Bachelor’s Degree.
• Required: Customer Service.
• Desired: Up to one year of related experience.
• Desired: Pharmacy Technician experience.

About the role

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.

PharMerica 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!