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 prompt billing.

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

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

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

• Work collaboratively with the team to identify, document, communicate, and address payer and billing trends and concerns.

• Assess and convert billing exception reports to guarantee claims are billed to the correct financial plans.

• Create and maintain reports and records for processing purposes.

• Execute additional assigned responsibilities.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Experience in Customer Service is essential.

• Capacity to retain extensive information and apply that knowledge to relevant situations.

• Ability to thrive in a fast-paced environment.

• Basic math skills are required.

• Proficiency in Microsoft Office Suite.

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

• Up to one year of related experience is preferred.

• Experience as a Pharmacy Technician is preferred.

• Familiarity with trends, directions, major issues, regulatory considerations, and trendsetters in the insurance industry is desirable.

• Certification as a Pharmacy Technician 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.