Adjudicator Point of Sale

PharMerica

Step Into a Rewarding Role as an Adjudicator, Point of Sale with PharMerica!

Are you ready to make a real impact in a growing organization? Join our PharMerica team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters-delivering exceptional care and service.

Why Join PharMerica?

Focused on Service Excellence: Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation.
• Career Growth: We're in high growth mode, offering plenty of opportunities for those looking to advance their careers.
• Remote Flexibility: This position is 100% remote, giving you the freedom to work from anywhere!

This is an excellent opportunity for a Pharmacy Technician to move from a retail to office environment and who is willing to learn claims, billing and insurance processing.

Our ideal candidate is a Pharmacy Technician with knowledge of pharmaceuticals.

This is a remote position; You may reside anywhere within the Continental USA.

What You'll Do: As a dynamic Adjudicator Point of Sale, you will:

• Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need.
• Be a vital part of a team that's dedicated to enhancing patient care through meticulous claims management and customer service.

What We Offer:

• 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

This position will be posted for a minimum of 5 days

The Claims Specialist - 3rd Party:

• Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks
• Researches, analyzes and appropriately resolves 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
• Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes
• Works as a team to identify, document, communicate and resolve payer/billing trends and issues
• Reviews and works to 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

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