Claims Specialist / 3rd Party

PharMerica

 

Are you ready to make a real impact in a growing organization? Join our PharMerica team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters—delivering exceptional care and service.

 

 

• →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

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

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

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.

 

USD $21.00 - $23.00 / Hour