Pharmacy Claims Processor

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

📋 Description

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

• Investigate, analyze, and resolve rejected claims involving Medicare Part D plans, third-party insurance providers, and state Medicaid plans.

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

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

• Identify, document, communicate, and resolve trends and issues related to payers and billing collaboratively as part of a team.

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

• Compile and maintain reports and records for processing activities.

• Carry out other assigned responsibilities.

⛳️ Requirements

• A High School Diploma or GED is mandatory.

• Experience in Customer Service is essential.

• Capacity to retain a significant amount of information and apply that knowledge to relevant situations.

• Ability to thrive in a fast-paced environment.

• 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 related experience is preferred.

• Experience as a Pharmacy Technician is preferred.

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

• Certification as a pharmacy technician 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