Claims Analyst - 3rd Party

PharMerica

PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

Step Into a Rewarding Role as a Claims Analyst with PharMerica!

The 3rd Party Claims Analyst is responsible for configuring 3^rd party insurance setups within our proprietary system, and monitoring and evaluating events related to 3^rd party claims. The 3^rd party analyst will interact with appropriate departments to ensure integrity of third party claim information and provide pharmacy operations support. The position specializes in pharmacy claim billing and reimbursement detail. Analyst are considered experts in Medicare Part D, Medicaid, and Commercial insurance. The analyst will also assist with special projects and ad hoc assignments as needed.

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!

What You'll Do: As a dynamic Claims Specialist, 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 are looking for:

• Experience in Customer Service
• Required: 2+ yrs experience as a Pharmacy Technician or in a billing position within a healthcare setting
• Required: 1+ yrs experience with pharmacy or health data analysis
• Required: 1+ yrs experience working in a Pharmacy, Long Term Care or Managed Care setting
• Ability to work in the Eastern Time Zone

This is a remote opportunity. Applicants can reside anywhere within the Continental USA but must be able to support the Eastern Time Zone.

Schedule: Monday through Friday, 8:00 a.m. to 5:00 p.m.

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

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

This position will be posted for a minimum of 7 days

• Communicate effectively and professionally with 3rd party entities including Pharmacy Benefit Managers (PBM's), pharmacy claim switches, and other vendors regarding claim or plan inquiries.
• Understand various payer requirements and configure billing parameters within proprietary software to send online transactions to and from 3rd party insurance payers in accordance with HIPAA named standards set forth by the National Council for Prescription Drug Programs (NCPDP)
• Review 3rd party payer sheets for specific configuration details. Construct telecom standard field specific templates for each payer
• Communicate with Switching company to construct external pre and post claim edits to prevent claim denials and ensure proper reimbursement.
• Send and receive contracts on behalf of the Director of 3rd Party Network Services. Work with Compliance team to obtain, reissue, or renew Medicaid provider ID's, and work with other internal teams across the organization.
• Serve as Subject Matter Expert (SME) on cross functional work groups
• Provide operational support and troubleshooting to resolve both internal and external inquiries.
• Research and resolve complex billing issues with available resources and tools. This includes researching both denied and paid claim transactions, understanding root cause for denied claims or under reimbursement on paid claims, implementing methods to reduce such claims, or educating pharmacies on prevention opportunities.
• Ensure all industry and/or payer related changes are communicated throughout the organization
  * Independently and accurately manage workload in a timely manner with minimal direction. Communicate when competing priorities cannot be managed independently.
• Prepare recurring reports related to claim denials or payments.
• Query, massage, and analyze small to medium sums of claim data. Summarize and report findings to executive management or other internal teams
• Support project teams in the development of functional requirements
• 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.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• HS Diploma, GED or equivalent experience is required
• Desired: Associate or Bachelor's degree
• 2+ yrs experience as a Pharmacy Technician or in a billing position within a healthcare setting is required
• 1+ yrs experience with pharmacy or health data analysis is required
• 1+ yrs experience working in a Pharmacy, Long Term Care or Managed Care setting is required
• Excellent verbal and written communication skills needed
• Excellent time management skills; ability to work independently and manage multiple/competing priorities required
• Proven ability to work with a high degree of accuracy and attention to detail
• Proficient in all Microsoft Word and Outlook
• Demonstrated analytical skills, technical knowledge and creative problem solving techniques
• Ability to effectively navigate ambiguous situations with limited direction
• Advanced analytical skills with the ability to interpret and synthesize complex data sets
• Able to handle high volume and significant workload
• Query building experience through use of Microsoft Access or other proprietary systems is a preference
• Familiarity with long term care pharmacy or facility billing practices is a preference

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

Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.