Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues,
is the second largest institutional pharmacy company in America.
operates more than 100 institutional pharmacies in over 40 states and serves nursing facilities that care for approximately 350,000 patients.
is recruiting a
Full-Time 3rd Party Claims Processor I
to provide prompt and courteous service to customers ensuring timely provision of medications to customers, and reimbursement to PharMerica.
Verifies information to ensure accurate processing and resolve potential clinical and non-clinical issues for contacting payors and other outside agencies.
Ensures approval of claims through performing reverses as necessary on edits discovered during the filing process (wrong NDC Number, refills to soon, brand v. generic, etc) by resolving discrepancies with Purchasing Associates, pharmacists, DON or Nurse.
Identifies and proactively resolves denied claims prior to medication delivery, working with insurance companies, Medicaid, nursing facilities and family members to ensure minimal loss of non-reimbursed inventory.
Follow-up with Directors of Nursing and Nursing Staff to communicate unresolved denials or status changes allowing alternate courses of therapy to be prescribed.
Completes the necessary authorization forms (Certification of Medical Necessity, Prior Authorization Forms, etc) to ensure appeals are executed in with physicians, DON’s and Claims Processors in a timely manner.
Minimizes exposure for incorrectly billed medications by working with nursing staff in processing reverse and credit returns on refused medications.
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.
High School Diploma or GED Equivalent; Associate Degree preferred
1-2 years customer service experience required
1 year adjudication in a pharmacy billing environment, 6 months retail pharmacy technician experience preferred
Knowledge of insurance billing processes, POS, Medicare, Medicaid required
Customer Service, oral communication, detail Orientation, results orientation, teamwork, problem solving
Interested candidates please apply on-line @
PharMerica - 13 months ago
The only time you'll see PharMerica's products is when a nurse hands you a pill in a paper cup. It is the country's...