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 rectify 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 maximize payer reimbursement potential.

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

• Recognize, document, communicate, and resolve payer and billing trends and challenges collaboratively with the team.

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

• Prepare and uphold processing reports and documentation.

• Carry out other assigned responsibilities.

⛳️ Requirements

• High School Diploma or GED is required.

• Experience in Customer Service is essential.

• Ability to retain a substantial amount of information and apply that knowledge to relevant situations.

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

• Basic math skills are necessary.

• Proficiency in Microsoft Office Suite is required.

• Experience as a Pharmacy Technician 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.

• Willingness to learn about claims, billing, and insurance processing is expected.

• Availability to work nights and weekends is required.

🏝️ 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