LTC Pharmacy Claims Specialist

Job Summary

To support a growing organization, the full-time LTC Pharmacy Claims Specialist will manage and resolve pharmacy claims efficiently in a 100% remote environment, ensuring clients receive the necessary pharmaceutical support.

Key responsibilities

• Manage a portfolio of rejected pharmacy claims to maximize payer reimbursement and ensure timely billing
• Research and resolve rejected claims by collaborating with Medicare D plans, third-party insurance companies, and state Medicaid plans
• Monitor and address revenue risks associated with payer setup, billing, rebilling, and reversal processes

Required qualifications

• High School Diploma or GED required; Associate's or Bachelor's Degree preferred
• Customer service experience required; up to one year of related experience preferred
• Basic math aptitude and proficiency in Microsoft Office Suite required
• Ability to retain and apply a large amount of information in a fast-paced environment
• Pharmacy technician certification is preferred but not required