Pharmacy Claims Processor / Remote

Step into a rewarding role as a Claims Specialist with PharMerica! Join our team 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 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 advancement.
• Remote Flexibility: This position is 100% remote, giving you the freedom to work from anywhere.

Responsibilities

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
• Research, analyze, and appropriately resolve 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.
• Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
• Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes.
• Work as a team to identify, document, communicate, and resolve payer/billing trends and issues.
• Review and work to convert billing exception reports to ensure claims are billed to accurate financial plans.
• Prepare and maintain reports and records for processing.
• Perform other tasks as assigned.

Requirements

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 certification, 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

About Our Line of Business

Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider.

www.ameritaiv.com

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.