BrightSpring Health Services

CLAIMS SPECIALIST

Job Locations US-MA-TAUNTON
ID
2020-3923
Line of Business
PharMerica

Our Line of Business

PharMerica logo_no tag

Overview

Accelerate your career!  We apply innovative solutions that improve patient outcomes through some of the industry’s best and brightest business professionals, innovators and clinicians.  Right now, we have an exciting opportunity for you to join our team as a Claims Specialist.

Responsibilities

  • Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
  • 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.

Qualifications

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.

About our Line of Business

PharMerica is 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.  PharMerica is one of the nation's largest pharmacy companies.  PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.  For more information about PharMerica, please visit www.pharmerica.com.  Follow us on FacebookTwitter, and LinkedIn.

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