3rd Party Claims Specialist I:
PharMerica

39392-en_US
PharMerica
Taunton Sout
Pharmacy
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Description

A full-service pharmacy solution providing value beyond medication.

PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. With over $3 billion annual revenues, PharMerica is one of the nation's largest pharmacy companiesPharMerica operates more than 105 institutional pharmacies in 47 states serving over 350,000+ patients daily.

 

PharMerica offers unmatched employee development. Exceptional company culture. Seemingly endless opportunities for advancement and the highest hiring goals in decades.

 

 

PharMerica - Corporate Office in Taunton, 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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