ADJUDICATOR, POINT OF SALE

PharMerica

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

We are seeking dynamic Adjudicators-Point of Sale with 3^rd party claims experience. Pharmacy Technicians seeking an alternative career move from the retail environment are desired

This is a remote position. Applicants can live anywhere within the continental USA.

Schedule: Monday-Friday, 8:30am to 5:00pm Central time Zone

We offer:

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life insurance benefits

Company paid STD and LTD

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

If your passion is service excellence and top-quality care come join our team and apply today!

*Position will be posted for a minimum of 7 business days

The Claims Specialist - 3rd Party:

Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
• Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
• Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes
• Works as a team to identify, document, communicate and resolve payer/billing trends and issues
• Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans
• Prepares and maintains reports and records for processing
• Performs other tasks as assigned

Education/Learning Experience:

• Required: High School Diploma or GED
• Desired: Associate's or Bachelor's Degree

Work Experience:

• Required: Customer Service
• Desired: Up to one year of related experience. Pharmacy Technician experience

Skills/Knowledge:

• Required: Ability to retain a large amount of information and apply that knowledge to related situations. Ability to work in a fast-paced environment. Basic math aptitude. Microsoft Office Suite
• Desired: Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations and trendsetters

Licenses/Certifications:

• Desired: Pharmacy technician, but not required