3rd Party Claims Specialist I:

Brockton Massachusetts

PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.



Essential Functions:

  • Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to PharMerica and their customers.
  • Research, analyze and appropriately resolve 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.
  • Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
  • Contact providers and/or customers as necessary to obtain additional information.
  • Monitor and resolve at risk revenue associated with payer set up, billing, rebilling and reversal processes.
  • Work as a team to identify, document, communicate and resolve payer/billing trends and issues
  • Timely complete, communicate and submit necessary payer paperwork including but not limited to prior authorizations forms and manual billing.
  • Review and work convert billing exception reports to ensure claims are billed to accurate financial plans.
  • Complete billing transactions for non standard order entry situations as required.
  • Support training needs
  • Prepares and maintains reports and records for processing.
  • Performs other tasks as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.  Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Minimum Qualifications:

Education/Learning Experience

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

Work Experience

  • Required: 1 yr. medical claims processing experience.
  • Desired:  Up to one year of related experience.  Pharmacy Technician experience.


  • 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.


  • Desired:   Pharmacy technician

Behavior Competencies

  • Required:  Customer Service.  Oral and written communication.   Detail Orientation.  Results Orientation.  Teamwork. Adaptability to an ever changing environment.
  • Desired: Analytical and problem solving




Accelerate Your Career with PharMerica!

Basic Qualifications