3rd Party Claims Specialist I:
PharMerica

34928-en_US
PharMerica
Brockton Massachusetts
Pharmacy
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Description

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 the second largest institutional pharmacy company in America. PharMerica operates more than 100 institutional pharmacies in over 40 states and serves nursing facilities that care for approximately 350,000 patients.

PharMerica  - Corporate Office in Brockton, Massachusetts is recruiting a 3rd Party Claims Specialist I to join our team.  Ensure maximum reimbursement by resolving payer rejected claims with critical deadlines while adhering to compliance standards and mitigating financial risk to PharMerica and our customers in a high volume, fast paced environment.

 

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.
  • 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
  • Review and work 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.
  • 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.

 

Minimum Qualifications (Will Provide Training!):

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; however, WILL TRAIN!  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.

EOE M/F/D/V

Accelerate Your Career with PharMerica!

Basic Qualifications
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