Claims Specialist

3 weeks ago


Taunton, Massachusetts, United States PharMerica Full time
Job Title: Claims Specialist

We are seeking a highly skilled Claims Specialist to join our team at PharMerica. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.

Responsibilities:
  • Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
  • Research, analyze, and resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans.
  • Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
  • Monitor and resolve at-risk revenue associated with payer set up, billing, rebilling, and reversal processes.
  • Work as a team to identify, document, communicate, and resolve payer/billing trends and issues.
  • Review and work to convert billing exception reports to ensure claims are billed to accurate financial plans.
  • Prepare and maintain reports and records for processing.
Qualifications:
  • High School Diploma or GED.
  • Up to one year of related experience.
  • Pharmacy Technician experience is a strong preference.
  • Ability to retain a large amount of information and apply that knowledge to related situations.
  • Ability to work in a fast-paced environment.
  • Basic math aptitude.
About PharMerica:

PharMerica is a full-service pharmacy solution providing value beyond medication. We are the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations, and post-acute care organizations.

We offer a non-retail pharmacy environment, competitive pay, flexible schedules, and a range of benefits, including health, dental, vision, and life insurance, as well as tuition assistance and employee discounts.


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