Claims Processing Specialist

2 weeks ago


Longmont, Colorado, United States PharMerica Full time

Company Overview

PharMerica

About Us

At PharMerica, we pride ourselves on being a premier closed-door pharmacy dedicated to meeting the pharmaceutical needs of our long-term care and senior living clients. Our non-retail environment allows us to focus on providing exceptional service, and as we continue to grow, we offer numerous opportunities for career advancement.

Position Summary

We are currently looking for motivated Claims Processing Specialists with experience in third-party claims. This role is ideal for Pharmacy Technicians seeking a transition from retail pharmacy settings.

Work Environment

This is a remote position, allowing applicants to work from anywhere within the continental USA.

Schedule

Monday to Friday, 8:30 AM to 5:00 PM Central Time Zone.

What We Offer

  • DailyPay
  • Flexible scheduling options
  • Competitive compensation
  • Shift differentials
  • Comprehensive health, dental, vision, and life insurance
  • Company-paid short-term and long-term disability
  • Employee discount programs
  • 401(k) retirement plan
  • Paid time off
  • Tuition reimbursement

Key Responsibilities

The Claims Processing Specialist will:

  • Manage and analyze a portfolio of rejected pharmacy claims to ensure optimal reimbursement and timely billing.
  • Investigate and resolve rejected claims by collaborating with national Medicare D plans, third-party insurers, and state Medicaid programs.
  • Perform necessary edits and reversals to secure claim approvals and maximize reimbursement.
  • Monitor revenue risks associated with payer setups, billing, and reversal processes.
  • Collaborate with team members to identify and address billing trends and issues.
  • Review billing exception reports to ensure claims are submitted to the correct financial plans.
  • Maintain accurate reports and records related to claims processing.
  • Complete 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 relevant experience, particularly in pharmacy settings.

Skills:

  • Required: Strong retention of information and application in relevant situations, ability to thrive in a fast-paced environment, basic math skills, proficiency in Microsoft Office Suite.
  • Preferred: Familiarity with insurance industry trends and regulations.

Licenses/Certifications:

  • Preferred: Pharmacy Technician certification, though not mandatory.

About PharMerica

PharMerica is a comprehensive pharmacy solution provider, delivering value beyond medication. We are the preferred pharmacy services provider for senior living communities, skilled nursing facilities, public health organizations, and post-acute care facilities. PharMerica is one of the largest pharmacy companies in the nation, offering unmatched employee development, a vibrant company culture, and extensive opportunities for advancement.

Salary Range

USD $23.00 / Hour



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