Health, Dental, Vision, and Life Insurance
Company-Paid Disability Insurance
Tuition Assistance & Reimbursement
Employee Discount Program
401k Plan
Paid Time Off
Non-Retail, Closed-Door Environment
Responsibilities
The Claims Specialist - 3rd Party
Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
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
Prepares and maintains reports and records for processing
Performs other tasks as assigned
Qualifications
Education/Learning Experience
Required: High School Diploma or GED
Desired: Associate’s or Bachelor’s Degree
Work Experience
Required: Customer Service
Desired: Up to one year of related experience. Pharmacy Technician experience
Skills/Knowledge
Required: 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
Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters
Licenses/Certifications
Desired: Pharmacy technician, but not required
About our Line of Business
PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.
Additional Job Information
This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing.
Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.
