Pharmacy Claims Processor

Job not on LinkedIn

🕒 2 days ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

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BrightSpring Health Services

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

💊 Pharmaceuticals

⚕️ Healthcare Insurance

🔥 Funding within the last year

💰 $881M Post-IPO Secondary on 2026-06

Healthcare • Pharmaceuticals • Healthcare Insurance

BrightSpring Health Services is a leading provider of independent health services for complex populations in the United States. The company delivers a broad set of care services including home health, hospice, personal care, neurorehabilitation and other rehabilitation services; provider services; and extensive pharmacy offerings (infusion & specialty pharmacies, home and community pharmacies) through brands such as Onco360®. BrightSpring also operates managed care lines including home-based primary care and managed care plans, and emphasizes clinical quality, outcomes (for example, reported reductions in hospitalizations with home-based primary services), and patient satisfaction across its businesses.

📋 Description

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing • Research, analyze, and resolve rejected claims with Medicare Part D plans, third-party insurance companies, and state Medicaid plans • Perform edits and/or reversals to obtain claim approvals and maximize payer reimbursement • Monitor and resolve at-risk revenue associated with payer setup, billing, rebilling, and reversal processes • Identify, document, communicate, and resolve payer and billing trends and issues as part of a team • Review and convert billing exception reports to ensure claims are billed to accurate financial plans • Prepare and maintain processing reports and records • Perform other assigned tasks

🎯 Requirements

• High School Diploma or GED • Customer Service experience • 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 • Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference • Associate’s or Bachelor’s Degree is desired, but not required • Pharmacy technician certification is desired, but not required • Willingness to learn claims, billing, and insurance processing • Availability for nights and weekends

🏖️ Benefits

• 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 • 100% remote work

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