Claims Specialist

About the Role:

As a Claims Specialist at PharMerica, you will play a vital role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. Your primary responsibility will be to manage and resolve rejected pharmacy claims efficiently, thereby maximizing payer reimbursement and reducing financial risks.

Why Choose This Opportunity?

• Competitive Pay with Shift Differentials: Earn a salary of $19.00-$21.00 per hour, reflecting your expertise and commitment.
• Remote Flexibility: Work from anywhere, enjoying the freedom to balance your work and personal life.
• Career Growth: PharMerica offers numerous opportunities for advancement, allowing you to grow professionally and personally.
• DailyPay: Enjoy flexible schedules and timely pay.
• Comprehensive Benefits: Receive health, dental, vision, and life insurance, as well as company-paid disability insurance and tuition assistance.
• Employee Discount Program: Take advantage of exclusive discounts on various products and services.
• 401k Plan: Secure your future with a competitive retirement savings plan.
• Paid Time Off: Relax and recharge with paid vacations and holidays.

Responsibilities:

You will be responsible for:

• Managing a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement.
• Researching, analyzing, and resolving rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans.
• Ensuring approval of claims by performing appropriate edits and/or reversals.
• Monitoring and resolving at-risk revenue associated with payer set up, billing, rebilling, and reversal processes.
• Working as a team to identify, document, communicate, and resolve payer/billing trends and issues.
• Preparing and maintaining reports and records for processing.

Qualifications:

• High School Diploma or GED required; Associate's or Bachelor's Degree desired.
• Customer Service experience required; up to one year of related experience preferred, including Pharmacy Technician experience.
• Able to retain a large amount of information and apply it to related situations.
• Basic math aptitude and Microsoft Office Suite skills required.

About PharMerica:

PharMerica is a full-service pharmacy solution providing value beyond medication. As the long-term care pharmacy services provider of choice, we offer unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement, and the highest hiring goals in decades. Learn more about PharMerica at www.pharmerica.com.