Remote Evening Shift Pharmacy Billing & Claims Adjudication Specialist – LTC Expertise, Medicare Part D & Prior Authorization

Why Join Workwarp? – A Visionary Leader in Remote Healthcare Solutions

At Workwarp, we are redefining the way healthcare services are delivered across the United States. Our mission is to empower pharmacy professionals with cutting‑edge technology, flexible work environments, and a culture that celebrates innovation, integrity, and collaboration. As a rapidly expanding leader in remote pharmacy operations, we partner with long‑term care (LTC) facilities, skilled nursing homes, and community health providers to ensure accurate, timely, and compliant medication billing and claims adjudication. Our people are the cornerstone of our success, and we invest heavily in their growth, well‑being, and professional fulfillment. If you thrive in a fast‑paced, detail‑oriented setting and are eager to make a tangible impact on patient outcomes, you have found your next career home.

Position Overview – Evening Shift Pharmacy Billing & Claims Adjudication Specialist

We are seeking a highly motivated Remote Evening Shift Pharmacy Billing & Claims Adjudication Specialist to join our MAC Rx Billing team. This full‑time role (6 pm – 2:30 am) offers the flexibility of a work‑from‑home environment while delivering critical adjudication services for long‑term care pharmacy accounts. You will be the primary point of contact for processing admissions, managing insurance verification, handling prior authorizations, and ensuring compliance with federal and state regulations, including HIPAA.

Key Responsibilities

• Admissions & Demographics: Accurately enter resident demographic information, insurance coverage details, and medication orders into the LTC software platform, ensuring data integrity and completeness.
• Customer Billing Inquiries: Respond to pharmacy staff, residents, and family members with courteous, professional assistance regarding billing questions, statement reconciliation, and payment plans.
• Account Balance Management: Review resident account balances, identify discrepancies, and collaborate with residents or their authorized representatives to resolve outstanding charges.
• Regulatory Compliance: Apply all applicable federal and state pharmacy laws, including HIPAA, Medicare Part D regulations, and Medicaid guidelines, to protect patient privacy and maintain audit‑ready records.
• Live Claim Adjudication: Perform real‑time claim adjudication, verify eligibility, apply appropriate pricing rules, and resolve denials or rejections promptly.
• Prior Authorization Coordination: Initiate, track, and obtain prior authorizations for high‑cost or restricted medications, communicating status updates to prescribers and LTC facilities.
• Medication Delivery Oversight: Liaise with pharmacy distribution teams and LTC facilities to confirm timely, accurate delivery of prescribed medications, addressing any logistical challenges.
• Documentation & Reporting: Generate daily, weekly, and monthly reports on adjudication performance metrics, error rates, and compliance indicators for leadership review.
• Continuous Process Improvement: Identify workflow bottlenecks, propose automation or standardization solutions, and participate in team meetings aimed at enhancing efficiency.
• Team Collaboration: Work closely with fellow adjudicators, pharmacy technicians, billing specialists, and IT support to ensure seamless operations across all shifts.

Essential Qualifications – What You Must Bring

• Licensure: Active Pharmacy Technician License in Illinois (or ability to obtain within 90 days) and a valid Pharmacy Technician Certification (PTC).
• Experience: Minimum 1–3 years of hands‑on experience in a long‑term care pharmacy setting, with proven expertise in claims adjudication, insurance verification, and resident account management.
• Regulatory Knowledge: In‑depth understanding of Medicare Part D, Medicaid, public aid programs, and third‑party payer requirements, as well as familiarity with prior authorization processes.
• Technical Proficiency: Demonstrated ability to navigate LTC pharmacy software (e.g., MatrixCare, PointClickCare, or proprietary platforms) and electronic billing systems.
• Attention to Detail: Exceptional accuracy when entering data, reviewing claim submissions, and reconciling financial discrepancies.
• Communication Skills: Strong written and verbal communication abilities, enabling clear interaction with healthcare providers, residents, and internal teams.
• Self‑Motivation & Independence: Proven track record of thriving in a remote work environment, managing time efficiently, and meeting productivity targets without direct supervision.
• Availability: Willingness to work the designated evening shift (6 pm – 2:30 am) and flexibility to cover weekends or holidays as operational needs dictate.

Preferred Qualifications – Extra Credit

• Experience with framework LTC software for at least one year (e.g., MatrixCare, Cerner Lifecare).
• Background in health‑care revenue cycle management or pharmacy benefit management (PBM) functions.
• Knowledge of federal and state pharmacy statutes beyond Medicare Part D, such as the Omnibus Budget Reconciliation Act (OBRA) or state‑specific Medicaid waivers.
• Prior involvement in process‑improvement initiatives, Lean Six Sigma, or other quality‑enhancement methodologies.
• Multilingual abilities, particularly Spanish, to support diverse resident populations.

Core Skills & Competencies – The Blueprint for Success

• Analytical Thinking: Ability to dissect complex claim scenarios, identify root causes of denials, and implement corrective actions.
• Customer Service Excellence: Empathy and professionalism when addressing resident or family concerns about billing or medication costs.
• Time Management: Skillful juggling of multiple adjudication queues, ensuring deadlines are met and service level agreements (SLAs) are maintained.
• Technology Aptitude: Comfort with cloud‑based platforms, electronic health record (EHR) integration, and data‑entry tools.
• Regulatory Acumen: Up‑to‑date knowledge of evolving Medicare Part D formularies, state Medicaid updates, and HIPAA privacy rules.
• Team Collaboration: Open‑minded approach to sharing knowledge, mentoring new hires, and contributing to a positive remote‑team culture.
• Problem‑Solving: Proactive identification of issues, swift escalation when needed, and development of practical solutions.

Compensation, Perks & Benefits – Investing in Your Well‑Being

Competitive Salary commensurate with experience, supplemented by a comprehensive benefits package designed to support your health, financial security, and work‑life balance.

• Health & Wellness: Medical, dental, and vision insurance plans with employer contributions.
• Retirement Planning: 401(k) plan with generous company matching to help you build long‑term financial stability.
• Paid Time Off (PTO): Earned vacation, sick leave, and paid holidays to recharge and attend to personal matters.
• Disability & Life Coverage: Short‑term and long‑term disability options, as well as life insurance protection for you and your loved ones.
• Remote Work Stipends: Home office allowance for ergonomic equipment, high‑speed internet, and ancillary tools that enhance productivity.
• Continuing Education: Reimbursement for relevant certifications, webinars, and industry conferences to keep your skills current.
• Employee Assistance Program (EAP): Confidential counseling services, mental‑health resources, and wellness initiatives.

Culture & Work Environment – A Remote Team That Feels Close‑Knitted

At Workwarp, we pride ourselves on cultivating an inclusive, supportive, and dynamic workplace— even when we’re spread across the country. Our core values shape every interaction:

• Integrity: We uphold the highest ethical standards in handling sensitive patient data and financial information.
• Collaboration: Virtual “coffee chats,” cross‑functional huddles, and peer‑to‑peer mentoring build strong bonds among remote teammates.
• Innovation: Employees are encouraged to propose new tools, workflow enhancements, and technology integrations that improve adjudication speed and accuracy.
• Recognition: Regular awards, shout‑outs, and performance bonuses celebrate achievements and milestones.
• Flexibility: While the evening shift has defined hours, we understand the importance of work‑life harmony and offer flexible scheduling options when possible.

Career Growth & Learning Opportunities – Your Path to Advancement

Workwarp invests in the professional trajectory of each associate. As a Pharmacy Billing & Claims Adjudication Specialist, you can expect:

• Mentorship from senior pharmacy operations leaders who guide you toward supervisory or managerial roles.
• Access to in‑house training modules covering advanced claims analytics, regulatory updates, and emerging pharmacy technologies.
• Opportunities to lead special projects, such as process‑automation initiatives or compliance audits, that showcase leadership potential.
• Clear promotion pathways: Adjudication Specialist → Senior Specialist → Team Lead → Operations Manager → Department Director.
• Cross‑departmental rotations, allowing exposure to pharmacy procurement, clinical services, or revenue cycle management.

How to Apply – Take the Next Step Toward a Rewarding Remote Career

If you are ready to bring your LTC pharmacy expertise, analytical mindset, and passion for accurate billing to a thriving remote team, we invite you to apply today. Submit your résumé and a compelling cover letter highlighting how your background aligns with the responsibilities and qualifications outlined above. Join Workwarp, and together we will shape the future of pharmacy billing excellence.

We Want to Hear From You!

Don’t let this opportunity pass you by. Click the link below to start your application process. We look forward to meeting the talented professional who will help us continue delivering seamless, compliant, and compassionate pharmacy services to residents nationwide.

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