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 rejected claims related to Medicare D plans, third-party insurance providers, and state Medicaid programs.

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

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

• Recognize, document, communicate, and resolve payer and billing patterns and issues collaboratively as part of a team.

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

• Prepare and maintain processing reports and documentation.

• Carry out other assigned duties.

⛳️ Requirements

• High School Diploma or GED.

• Experience in Customer Service.

• A background in pharmacy claims or adjudication is required.

• Capability 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.

• Experience as a Pharmacy Technician and/or knowledge of pharmaceuticals is highly preferred.

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

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