Pharmacy Claims Processor

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

📋 Description

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

• Investigate, assess, and resolve denied claims with Medicare Part D plans, third-party insurers, and state Medicaid programs.

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

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

• Collaborate with team members to identify, document, communicate, and resolve issues and trends in payer and billing practices.

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

• Prepare and maintain documentation and records for processing purposes.

• Carry out other assigned responsibilities.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Customer service experience is essential.

• Capability to retain a substantial amount of information and apply it to relevant situations.

• Ability to thrive in a fast-paced work environment.

• Basic proficiency in mathematics.

• Familiarity with Microsoft Office Suite.

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

• Up to one year of relevant experience is preferred.

• Pharmacy Technician experience is desired/preferred.

• Understanding of industry trends, key issues, regulatory considerations, and influencers in the insurance sector is preferred.

• 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