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Pharmacy Claims Processor
BrightSpring Health Services. Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing pharmacy claims, ensuring maximum payer reimbursement, and resolving billing issues. Proficient in analyzing trends within the insurance industry and applying knowledge of pharmaceuticals to enhance claim processing efficiency.
Highest-signal resume keywords
Pharmacy Claims ManagementCustomer Service ExperienceKnowledge Of PharmaceuticalsMicrosoft Office SuitePharmacy Technician Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim ResolutionBilling ProcessesData AnalysisFinancial ReportingBasic Math Aptitude
Soft Skills
Information RetentionFast-Paced Work Adaptability
Certifications & Qualifications
Pharmacy Technician Certification
Industry Keywords
Medicare D PlansThird-Party InsuranceState Medicaid PlansPayer ReimbursementBilling Trends
About the role
Key responsibilities & impact- Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing
- Research, analyze, and resolve rejected claims with Medicare D plans, third-party insurance companies, and state Medicaid plans
- Perform edits and/or reversals to secure claim approval and maximum payer reimbursement
- Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes
- Identify, document, communicate, and resolve payer and billing trends and issues as part of a team
- Review and convert billing exception reports to ensure claims are billed to accurate financial plans
- Prepare and maintain processing reports and records
- Perform other assigned tasks
- Process pharmacy claims for PharMerica’s long-term care, senior living, and healthcare clients
Requirements
What you’ll need- High School Diploma or GED required
- Customer Service 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
- Pharmacy technician experience and/or knowledge of pharmaceuticals strongly preferred
- Up to one year of related experience desired
- Associate’s or Bachelor’s Degree desired
- Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters desired
- Pharmacy technician certification desired but not required
Benefits
Comp & perks- DailyPay
- Flexible Schedules
- Competitive Pay with Shift Differentials
- Health, Dental, Vision, and Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
- 100% remote work flexibility