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 D plans, third-party insurers, and state Medicaid programs.

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

• Track and address at-risk revenue associated with payer setup, billing, rebilling, and reversal activities.

• Work collaboratively with the team to identify, document, communicate, and rectify payer and billing patterns and challenges.

• Examine and transform billing exception reports to guarantee 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 is mandatory.

• Experience in Customer Service is essential.

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

• Ability to thrive in a fast-paced setting.

• Basic mathematical skills are required.

• Proficiency in Microsoft Office Suite is necessary.

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

• Up to one year of relevant experience is desirable.

• Experience as a Pharmacy Technician is preferred.

• Familiarity with the insurance industry's trends, directions, major issues, regulatory considerations, and trendsetters 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