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Requisition: 2024-144829 CLAIMS PROCESSING LEAD Job Locations US-WA-VANCOUVER ID 2024-144829 Line of Business PharMerica Position Type Full-Time Pay Min USD $25.00/Hr. Pay Max USD $25.00/Hr. Our Company PharMerica Overview Join our PharMerica team! 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! Join our PharMerica team! 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! We are seeking individuals who have experience in Pharmacy who are ready to make a change. This is an excellent opportunity for Pharmacy Technicians to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing. Remote position. Applicants can reside anywhere with the continental USA. Schedule: Tuesday through Friday 10am to 9pm Pacific TimeZone. Must be able to effectively support the Pacific Time Zone. We offer: DailyPay Flexible schedules Competitive pay Shift differential Health, dental, vision and life insurance benefits Company paid STD and LTD Tuition Assistance Employee Discount Program 401k Paid-time off Tuition reimbursement 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 minimumof 8 days Responsibilities * 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. * Make outbound phone calls to providers and/or customers as necessary to obtain additional information. * 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 * Timely complete, communicate and submit necessary payer paperwork including but not limited to benefit eligibility assessment, claim to old overrides and manual claim forms. * When necessary, will rebill claims electronically in accordance with NCPDP standards, online through payer specific websites, manually through Universal Claim Forms, or through other approved methods for favorable resolution of denied claims * Review and work convert billing exception reports to ensure claims are billed to accurate financial plans. * Complete billing transactions for non standard order entry situations as required. * Research, analyze and appropriately resolve non-traditional a