Pharmacy Claims Specialist

4 weeks ago


Longmont, Colorado, United States BrightSpring Health Services Full time
About the Role

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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