Pharmacy Claims Processor

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

📋 Description

• Oversee and identify a portfolio of rejected pharmacy claims to guarantee optimal payer reimbursement and prompt billing.

• Investigate, analyze, and rectify rejected claims with Medicare D plans, third-party insurance providers, and state Medicaid programs.

• Execute edits and/or reversals to obtain claim approval and maximize payer reimbursement.

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

• Recognize, document, communicate, and resolve payer and billing trends and issues collaboratively.

• Examine and convert billing exception reports to ensure claims are submitted to accurate financial plans.

• Prepare and uphold processing reports and records.

• Undertake additional assigned responsibilities.

• Process pharmacy claims for PharMerica’s long-term care, senior living, and healthcare clients.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Customer Service experience is essential.

• Ability to retain substantial information and apply it to related scenarios.

• Capability to thrive in a fast-paced environment.

• Basic proficiency in mathematics.

• Familiarity with Microsoft Office Suite.

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

• Up to one year of relevant experience is desired.

• An Associate’s or Bachelor’s Degree is preferred.

• Awareness of trends, directions, major issues, regulatory considerations, and influencers in the insurance industry is desired.

• Pharmacy technician certification is preferred but not mandatory.

🏝️ 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 flexibility.