Pharmacy Claims Specialist

PharMerica

Make the Move to PharMerica- Claims Specialist Opportunity!

Ready to take your pharmacy experience to the next level? PharMerica is looking for enthusiastic individuals to join our team as Claims Specialists in a closed-door, non-retail setting. This is the perfect chance to step out of retail and dive into the world of claims, billing, and insurance processing-all in an office environment that supports growth and career progression!

Why You'll Love This Role:

If you've got pharmacy technician experience or knowledge of pharmaceuticals, that's a big plus!
• Learn essential skills in claims processing while being part of a high-growth team.
• Enjoy a schedule designed with flexibility in mind.

Position Schedule:

1. Option 1: Monday 12-7 PM, Tuesday 9-6 PM, Wednesday OFF, Thursday 12-7 PM, Friday 9-6 PM, Saturday 9-6 PM, Sunday OFF
2. Option 2: Monday 10 AM-6 PM, Tuesday 2-10 PM, Wednesday 11 AM-7 PM, Thursday 2-10 PM, Friday 9-6 PM
3. Option 3: Monday 2-10 PM, Tuesday 1-8 PM, Wednesday 2-10 PM, Thursday 9-6 PM, Friday 9-6 PM

What We Offer:

• DailyPay: Access your earnings whenever you need!
• Flexible Schedules: Choose a schedule that works for you.
• Competitive Pay + Shift Differential: Recognizing your dedication.
• Health, Dental, Vision, and Life Insurance: Comprehensive benefits to keep you covered.
• Company-Paid Short & Long-Term Disability: Peace of mind for you and your family.
• Tuition Assistance & Reimbursement: Invest in your future with our support.
• Employee Discount Program: Save for what matters.
• Paid Time Off: Take the time you need to recharge.
• Closed-Door, Non-Retail Environment: Focus on delivering quality care and support!
• 401k: Invest in yourself!

Our pharmacy team takes pride in providing exceptional service to hospitals, rehab centers, and specialized care facilities across the country. If you're driven by service excellence and ready to make a meaningful impact, PharMerica is the place to be!

Apply now and start your new journey with us!

Position 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

This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing.

Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.