Service Excellence :

Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation.

Career Growth :

We're in high growth mode, offering plenty of opportunities for those looking to advance their careers.

Remote Flexibility :

This position is 100% remote, giving you the freedom to work from anywhere!

What You'll Do:

As a dynamic Claims Specialist, you will: Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need. Be a vital part of a team that's dedicated to enhancing patient care through meticulous claims management and customer service.

Shift:

Varying shifts available from 4:30am-12:00am. Overnight & Weekend shifts required. Must have pharmacy claims or adjudication background.

What We Offer:

DailyPay Flexible Schedules Competitive Pay with Shift Differentials 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. 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