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Claims Specialist

2 months ago

Taunton, Massachusetts, United States BrightSpring Health Services Full time
Unlock Your Potential as a Claims Specialist

Are you passionate about delivering exceptional service and making a real impact in a growing organization? We're seeking a skilled Claims Specialist to join our team at PharMerica, where you'll play a vital role in ensuring our clients receive the pharmaceutical support they need.

Why Choose PharMerica?
  • Service Excellence: Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation.
  • Career Growth: We're in high growth mode, offering plenty of opportunities for those looking to advance their careers.
  • Remote Flexibility: This position is 100% remote, giving you the freedom to work from anywhere.
What You'll Do:
  • Leverage your pharmacy claims experience to manage and resolve claims efficiently, ensuring our clients get the support they need.
  • Be a vital part of a team that's dedicated to enhancing patient care through meticulous claims management and customer service.
What We Offer:
  • DailyPay
  • Flexible Schedules
  • Competitive Pay with Shift Differentials
  • Health, Dental, Vision, and Life Insurance
  • Company-Paid Disability Insurance
  • Tuition Assistance & Reimbursement
  • Employee Discount Program
  • 401k Plan
  • Paid Time Off
  • Non-Retail, Closed-Door Environment

If you're passionate about service excellence and are looking for a role where you can grow and make a difference, we'd love to have you on our team. Apply today and start a fulfilling career with PharMerica.

Responsibilities:

  • 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:
    • Required: 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. Microsoft Office Suite
    • Desired: Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations and trendsetters
  • Licenses/Certifications:
    • Desired: Pharmacy technician, but not required

About our Line of Business:

PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit. Follow us on,, and.

Additional Job Information:

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 $ $21.00 / Hour