United States onlyOur Company
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!
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.
What we are looking for:
- Experience in Customer Service
- Experience in working with Medical Claims/Billing
- Pharmacy Technician experience, preferred
- Ability to work in the Eastern Time Zone
This is a remote opportunity. Applicants can reside anywhere within the Continental USA but must be able to support the Eastern Time Zone.
Schedule:Four, 10 hour days from Friday - Monday, 9:00AM-7:30PM Eastern Time (30 min lunch time)
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
About our Line of Business
PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.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.
