Pharmacy Claims Processor

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

📋 Description

• Oversee and assess a portfolio of denied pharmacy claims to maximize payer reimbursement and ensure timely billing, thereby mitigating financial risks.

• Investigate, analyze, and effectively resolve denied claims by collaborating with national Medicare D plans, third-party insurance providers, and all state Medicaid programs.

• Secure approval of claims by executing necessary edits and/or reversals.

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

• Collaborate as a team to identify, document, communicate, and resolve payer and billing trends and challenges.

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

• Prepare and maintain reports and records for processing purposes.

• Carry out other assigned duties as needed.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Customer service experience is essential.

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

• Ability to thrive in a fast-paced environment.

• Basic mathematical skills are necessary.

• Proficiency in Microsoft Office Suite is required.

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

• Up to one year of related experience is desirable.

• Experience as a Pharmacy Technician is preferred.

• Familiarity with insurance industry trends, directions, significant issues, regulatory considerations, and key influencers is preferred.

• Pharmacy technician license/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