Claims Processing Specialist

2 weeks ago


Taunton, Massachusetts, United States PharMerica Full time

Company Overview: PharMerica is a leading provider of pharmacy solutions, dedicated to delivering exceptional care and service to our long-term care and senior living clients.

Position Summary: Our Claims Processing Specialists play a vital role in managing our 3rd Party Claims operations. This position is ideal for individuals transitioning from retail pharmacy to a more structured office environment, where they can develop their skills in claims management, billing, and insurance processing. A background as a Pharmacy Technician or familiarity with pharmaceuticals is highly valued.

Work Environment: This is a REMOTE position, allowing you to work from anywhere within the continental United States.

Why Join PharMerica? As a closed-door pharmacy, we focus on meeting the pharmaceutical needs of our clients without the distractions of a retail setting. Our organization is experiencing significant growth, offering numerous opportunities for career advancement for those seeking to progress in their professional journey.

Work Schedule: Monday to Friday, 9 AM - 5:30 PM CST.

What We Offer:

  • DailyPay
  • Flexible scheduling options
  • Competitive compensation
  • Shift differentials
  • Comprehensive health, dental, vision, and life insurance
  • Company-paid short-term and long-term disability
  • Tuition Assistance and Reimbursement
  • Employee Discount Program
  • 401(k) plan
  • Paid time off

Key Responsibilities:

  • Manage and assess a portfolio of rejected pharmacy claims to maximize payer reimbursement and ensure timely billing.
  • Investigate, analyze, and resolve rejected claims by collaborating with national Medicare D plans, third-party insurers, and state Medicaid programs.
  • Ensure claim approvals by performing necessary edits and reversals to optimize reimbursement.
  • Monitor and address at-risk revenue related to payer setups, billing, rebilling, and reversal processes.
  • Collaborate with team members to identify, document, and resolve billing trends and issues.
  • Review and convert billing exception reports to ensure accurate financial plan billing.
  • Prepare and maintain processing reports and records.
  • Perform additional tasks as assigned.

Qualifications:

Education:

  • Required: High School Diploma or GED
  • Desired: Associate's or Bachelor's Degree

Experience:

  • Required: Customer Service experience
  • Desired: Up to one year of relevant experience, including Pharmacy Technician experience.

Skills:

  • Required: Strong retention of information, ability to thrive in a fast-paced environment, basic math skills, and proficiency in Microsoft Office Suite.
  • Desired: Understanding of insurance industry trends, regulations, and key issues.

Licenses/Certifications:

  • Desired: Pharmacy Technician certification, though not mandatory.

About PharMerica: PharMerica is a comprehensive pharmacy service provider, recognized for its commitment to delivering value beyond medication. We are the preferred pharmacy services provider for senior living communities, skilled nursing facilities, public health organizations, and post-acute care facilities. Our company prides itself on fostering employee development, maintaining a positive company culture, and offering abundant opportunities for career growth.

Salary Range: USD $26.00 / Hour



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