Claims Processing Specialist
2 weeks ago
Company Overview
BrightSpring Health Services
Position Summary
As a Claims Processing Specialist, you will play a vital role in our third-party claims operations. This position offers a unique opportunity for individuals transitioning from retail pharmacy settings to a professional office environment, where you will gain valuable experience in claims management, billing, and insurance processing.
Work Environment
This is a remote position, allowing you to work from anywhere within the continental United States. We encourage applicants from various regions, with a preference for candidates in specific areas.
Schedule
Monday to Friday, 9 AM - 5:30 PM CST
Benefits
We offer a comprehensive benefits package, including:
- DailyPay
- Flexible work schedules
- Competitive compensation
- Shift differentials
- Health, dental, vision, and life insurance
- Company-paid short-term and long-term disability
- Tuition assistance
- Employee discount programs
- 401(k) retirement plan
- Paid time off
- Tuition reimbursement
Role Responsibilities
The Claims Processing Specialist will:
- Manage and analyze a portfolio of rejected pharmacy claims to maximize reimbursement and ensure timely billing.
- Investigate and resolve rejected claims by collaborating with national Medicare D plans, third-party insurers, and state Medicaid programs.
- Ensure claim approvals through necessary edits and reversals to optimize reimbursement.
- Monitor revenue risks related to payer setups, billing, rebilling, and reversal processes.
- Collaborate with team members to identify and address billing trends and issues.
- Review billing exception reports to ensure accurate financial plan billing.
- Prepare and maintain processing reports and records.
- Perform additional tasks as assigned.
Qualifications
Education:
- Required: High School Diploma or GED
- Preferred: Associate's or Bachelor's Degree
Experience:
- Required: Customer service experience
- Preferred: Up to one year of related experience, particularly in pharmacy settings.
Skills:
- Required: Strong retention of information and application to relevant situations, ability to thrive in a fast-paced environment, basic math skills, proficiency in Microsoft Office Suite.
- Preferred: Familiarity with trends and regulations in the insurance industry.
Licenses/Certifications:
- Preferred: Pharmacy technician certification, though not mandatory.
About BrightSpring Health Services
BrightSpring Health Services is a leading provider of pharmacy solutions, delivering value beyond medication. We are dedicated to serving long-term care facilities, skilled nursing homes, public health organizations, and post-acute care providers. Our organization is committed to employee development, fostering a positive company culture, and offering numerous opportunities for career advancement.
Salary Range
USD $19.00 - $26.00 per hour
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