Pharmacy Claims Specialist

4 days ago


Uniondale, New York, United States BrightSpring Health Services Full time

We are seeking a highly skilled Claims Specialist to join our team at PharMerica. As a Claims Specialist, you will be responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.

Key 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

Requirements:

  • High School Diploma or GED
  • Customer Service experience
  • Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference

We offer a competitive salary and benefits package, including daily pay, flexible schedules, and opportunities for advancement. If you are a motivated and detail-oriented individual with a passion for claims and billing, we encourage you to apply for this exciting opportunity.



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