Remote Claims Adjudicator

3 weeks ago

Longmont CO, United States PharMerica Full time

PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today
We are seeking dynamic Adjudicators-Point of Sale with 3rd party claims experience. Pharmacy Technicians seeking an alternative career move from the retail environment are desired
This is a remote position. Schedule: Monday-Friday, 8:30am to 5:00pm Central time Zone
Flexible schedules
Shift differential
Health, dental, vision and life insurance benefits
Tuition reimbursement
Non-retail/Closed-door environment
If your passion is service excellence and top-quality care come join our team and apply today
*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
Associate’s or Bachelor’s Degree
Work Experience:
Microsoft Office Suite
Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters
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 Follow us on Facebook, Twitter, and LinkedIn.

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