Claims Processing Specialist
2 weeks ago
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
-
Claims Processing Specialist
2 weeks ago
Longmont, Colorado, United States PharMerica Full timeAbout PharMerica: PharMerica is a premier closed-door pharmacy dedicated to addressing the pharmaceutical needs of long-term care and senior living clients. We pride ourselves on providing a non-retail pharmacy environment that fosters growth and career advancement for our team members.Company Overview: Our organization is experiencing significant growth,...
-
Claims Specialist
1 week ago
Longmont, Colorado, United States BrightSpring Health Services Full timeAbout the RoleWe are seeking a highly skilled Claims Specialist - 3rd Party to join our team at BrightSpring Health Services. As a Claims Specialist - 3rd Party, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims...
-
Pharmacy Claims Adjudicator
4 days ago
Longmont, Colorado, United States BrightSpring Health Services Full timeAbout the RoleWe are seeking a highly skilled Claims Specialist - 3rd Party to join our team at BrightSpring Health Services. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims to ensure...
-
Surgical Instrument Processing Specialist
2 weeks ago
Longmont, Colorado, United States Pinnacle AlliancesHEALTH Full timePosition Overview:We are looking for a meticulous Surgical Instrument Processing Specialist to become a vital part of our healthcare team at Pinnacle Alliances/HEALTH. The successful candidate will play a crucial role in guaranteeing that all surgical tools and medical devices are effectively sterilized and preserved to meet the highest standards of patient...
-
Client Relations Specialist
2 weeks ago
Longmont, Colorado, United States Staff My Agency Full timeStaff My Agency is seeking a dedicated and compassionate individual to join our team as a Client Relations Specialist. This role emphasizes exceptional customer service and includes some sales responsibilities within a reputable agency environment.If you possess a natural ability to connect with clients and understand their needs, we invite you to be part of...
-
Billing Specialist for Orthopaedic Services
2 weeks ago
Longmont, Colorado, United States Orthopaedic & Spine Center of the Rockies PC Full timeJob OverviewThe Orthopaedic & Spine Center of the Rockies (OCR) has been a leading provider of orthopaedic services for over five decades. We are dedicated to delivering exceptional patient care and are in search of individuals who embody our core values and are eager to contribute to our mission.The Billing Specialist is responsible for managing the...
-
Chemical Process Analysis Engineer
2 weeks ago
Longmont, Colorado, United States Global Technical Talent Full timeJob Overview:Are you passionate about leveraging technology to enhance industry standards? Join us as we lead the market in storage solutions with unparalleled technology and products. We are seeking a knowledgeable Chemical Analysis Engineering Specialist. In this position, you will collaborate with engineers to execute experiments, conduct quality...
-
Chemical Process Support Engineer
2 weeks ago
Longmont, Colorado, United States Global Technical Talent Full timeJob Overview:Are you passionate about leveraging cutting-edge technology to enhance industry standards? Join us as we continue to lead the market in storage solutions with unparalleled technology and products.We are seeking a knowledgeable Chemical Analysis Engineering Specialist. In this position, you will collaborate with engineering teams to execute...
-
Certified Sterile Processing Specialist
5 days ago
Longmont, Colorado, United States UCHealth Full timeJob SummaryWe are seeking a highly skilled Sterile Processing Technician I to join our team at UCHealth. As a Sterile Processing Technician I, you will play a critical role in ensuring the highest level of patient care by processing and sterilizing medical instruments and equipment.Key ResponsibilitiesInstrument and Equipment Processing: Decontaminate and...
-
Homeowner Support Specialist
4 days ago
Longmont, Colorado, United States Lennar Homes Full timeJob SummaryWe are seeking a highly skilled and customer-focused Customer Service Representative to join our team at Lennar Homes. As a key member of our customer care team, you will be responsible for providing exceptional service to our homeowners, ensuring their satisfaction and loyalty to our brand.Key ResponsibilitiesPre-Construction Support: Conduct...
-
Data Entry Specialist
1 week ago
Longmont, Colorado, United States Ultimate Staffing Full timeJob SummaryUltimate Staffing is seeking a highly organized and detail-oriented Data Entry Specialist to support our customer service team. As a Data Entry Specialist, you will play a vital role in ensuring seamless customer experiences by accurately processing orders and responding to customer inquiries.Key Responsibilities:Assist customer service...
-
Automotive Sales Specialist
2 days ago
Longmont, Colorado, United States Fowler Automotive Full timeAbout the RoleFowler Automotive is seeking a highly motivated and results-driven Product Specialist to join our team. As a Product Specialist, you will be responsible for engaging with clients throughout the entire sales process, from initial inquiry to vehicle delivery.Key ResponsibilitiesImplement the sales process, from new client prospecting to vehicle...
-
Automotive Service Specialist
2 weeks ago
Longmont, Colorado, United States gpac Full timeAutomotive Service SpecialistJoin a dynamic team where your skills as an Automotive Service Specialist will be valued. We are looking for a knowledgeable and skilled individual with a strong background in automotive repair for cars and light trucks. Your role will involve diagnosing, maintaining, and repairing vehicles for our valued customers. Our company...
-
Accounts Payable Specialist
2 days ago
Longmont, Colorado, United States BBSI Colorado Full timeJob SummaryWe are seeking a highly organized and detail-oriented Accounts Payable Specialist to join our team at BBSI Colorado. As an Accounts Payable Specialist, you will be responsible for maintaining and updating our accounts payable ledger, processing invoices, and paying vendors. You will also assist the HR department with new employee onboarding,...
-
Precision Assembler Specialist
3 days ago
Longmont, Colorado, United States Aerotek Full time**Job Title:** Precision Assembler Specialist**Job Summary:**Aerotek is seeking a skilled Precision Assembler Specialist to join our team in a dynamic and innovative environment. As a key member of our team, you will be responsible for performing precise assembly of sub-assemblies and final assemblies, working under a microscope/magnifying glass to ensure...
-
Healthcare Billing Specialist
7 days ago
Longmont, Colorado, United States Orthopaedic & Spine Center of the Rockies PC Full timeJob OverviewCompany: Orthopaedic & Spine Center of the Rockies PCThe Medical Revenue Cycle Associate is a vital role within our organization, responsible for managing the intricacies of patient billing and charge entry. This position is essential for ensuring accurate and timely processing of patient demographic and insurance details, as well as office and...
-
MRI Imaging Specialist
2 weeks ago
Longmont, Colorado, United States Healthcare Support Permanent Placement Full timeHealthcare Support Permanent Placement is currently seeking a dedicated MRI Imaging Specialist to join our esteemed team.Position OverviewThe MRI Imaging Specialist plays a crucial role in delivering high-quality imaging services while ensuring patient safety and comfort. This position involves performing MRI scans and collaborating with healthcare...
-
MRI Imaging Specialist
2 weeks ago
Longmont, Colorado, United States Healthcare Support Permanent Placement Full timeHealthcare Support Permanent Placement is seeking a dedicated MRI Imaging Specialist to join our team. This role is essential in providing high-quality imaging services.Position OverviewThe MRI Imaging Specialist will be responsible for performing MRI scans while ensuring patient safety and compliance with organizational protocols.Key ResponsibilitiesConduct...
-
CNC Machining Specialist
7 days ago
Longmont, Colorado, United States 5280 Staffing Solutions Full timeJob OverviewWe are seeking to recruit skilled CNC Machining Specialists to join our team at 5280 Staffing Solutions.The ideal candidate will possess prior experience in the setup and/or programming of CNC machinery.As a CNC Machining Specialist, you will be responsible for setting up and operating various machine tools as assigned, while interpreting...
-
Property Leasing Specialist
2 weeks ago
Longmont, Colorado, United States Bell Partners Full timeJoin Our Team as a Property Leasing SpecialistAt Bell Partners, we are dedicated to fostering communities that our residents take pride in calling home. As a leading entity in the multi-family housing sector, we manage over 85,000 units across North America and are committed to continuous growth.Role Overview:The Property Leasing Specialist plays a crucial...