Pharmacy Claims Specialist
12 hours ago
We are seeking a highly skilled Pharmacy Claims Specialist to join our team at PharMerica. As a Pharmacy Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.
Key Responsibilities:- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
- Research, analyze, and appropriately resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and all 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.
- High School Diploma or GED.
- Customer Service experience.
- 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.
- Associate's or Bachelor's Degree.
- Up to one year of related experience. Pharmacy Technician experience.
- Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations, and trendsetters.
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 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 our website.
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