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Pharmacy Claims Specialist

4 months ago

Uniondale, United States PharMerica Full time

Our Company:
PharMerica

Overview:
**_ Join our PharMerica team_**_ 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 organization is in _**_high growth mode_**_, which means _**_advancement opportunities_**_ for individuals who are looking for career progression_

**_
Schedule: Part-time position_**

We offer:
DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life insurance benefits

Company paid STD and LTD

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

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:

- Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters

Licenses/Certifications:

- Desired: Pharmacy technician, but not required

**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.**

Salary Range: USD $17.00 - $18.00 / Hour