Pharmacy Claims Specialist
4 weeks ago
We are seeking a highly skilled Claims Resolution Specialist to join our team at PharMerica. As a Claims Resolution Specialist, you will be responsible for managing and identifying rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
Key Responsibilities:
- Researches, analyzes, and resolves rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans.
- 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.
Requirements:
- High School Diploma or GED required; Associates or Bachelor's Degree desired.
- Customer service experience required; up to one year of related experience or pharmacy technician experience desired.
- Ability to retain a large amount of information and apply that knowledge to related situations.
- Basic math aptitude and Microsoft Office Suite skills required.
What We Offer:
- DailyPay
- Flexible schedules
- Competitive pay
- Shift differential
- Health, dental, vision, and life insurance benefits
- Company-paid STD and LTD
- Employee Discount Program
- 401k
- Paid-time off
- Tuition reimbursement
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 unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement, and the highest hiring goals in decades.
Salary Range: USD $21.00 - $23.00 / Hour
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