Pharmacy Claims Processor

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Oversee and identify a portfolio of denied pharmacy claims to ensure optimal payer reimbursement and timely billing.

• Investigate, analyze, and resolve denied claims with Medicare Part D plans, third-party insurance providers, and state Medicaid programs.

• Execute edits and/or reversals to secure claim approvals and enhance payer reimbursement.

• Track and address at-risk revenue related to payer setup, billing, rebilling, and reversal procedures.

• Detect, document, communicate, and resolve payer and billing trends and issues collaboratively as part of a team.

• Review and transform billing exception reports to guarantee claims are billed to the correct financial plans.

• Prepare and maintain processing reports and records.

• Undertake other assigned tasks.

⛳️ Requirements

• High School Diploma or GED.

• Experience in Customer Service.

• Capability to retain extensive information and apply this knowledge to related scenarios.

• Ability to thrive in a fast-paced environment.

• Basic mathematical skills.

• Proficiency in Microsoft Office Suite.

• Pharmacy Technician experience and/or knowledge of pharmaceuticals is highly preferred.

• An Associate’s or Bachelor’s Degree is preferred but not mandatory.

• Pharmacy technician certification is preferred but not mandatory.

• Eagerness to learn about claims, billing, and insurance processing.

• Availability for evening and weekend shifts.

🏝️ Benefits

• 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.

• 100% remote work.