Claims Specialist
US-KY-LOUISVILLE
BrightSpring Health Services
Req #: 173421
Type: Full-Time
|
|
Overview: Step Into a Rewarding Role as a Claims Specialist with 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. This is a remote opportunity. Applicants can reside anywhere within the Continental USA. Schedule: Monday - Friday 3 pm-11 pm Mountain time Why Join PharMerica? * Focused on 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. * Pharmacy Technician experience, preferred 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
Share this job:
