Pharmacy Adjudication / Reimbursement Specialist
Position Summary
We are seeking a detail-oriented and motivated Pharmacy Adjudication / Reimbursement Specialist to join our team. This role is essential in ensuring accurate billing and reimbursement for prescriptions by verifying patient and insurance information, resolving claim issues, and maintaining compliance with payer regulations and guidelines. The ideal candidate thrives in a fast-paced environment and is committed to delivering high-quality service.
Schedule
Qualifications
State registration required
Pharmacy Technician Certification required within 1 year of hire
Strong attention to detail and organizational skills
Excellent written and verbal communication skills
Ability to multitask and manage competing priorities
Self-motivated with the ability to work both independently and as part of a team
Basic proficiency in Microsoft Word and Excel
Primary Responsibilities
Verify patient demographics and insurance information for accuracy
Ensure prescriptions are billed to the correct payer source in accordance with pricing, billing regulations, and utilization guidelines
Perform insurance verifications and eligibility checks
Handle inbound and outbound calls with facilities, guarantors, and insurance companies
Initiate and follow up on prior authorizations
Review and respond to insurance audit requests
Reconcile online third-party claims
Investigate and resolve insurance and Medicaid rejections from remittances
Maintain accurate documentation of all billing activities
Perform other duties as assigned
What You’ll Bring to the Team
As a Reimbursement Specialist, you will play a vital role in supporting our mission by ensuring accurate, timely billing and exceptional customer service. You will collaborate closely with team members to promote quality outcomes, operational efficiency, and overall employee satisfaction.
Why Join Us?
Supportive team environment
Opportunity for growth and certification
Meaningful work that impacts patient care behind the scenes
If you are a dedicated professional looking to grow your career in pharmacy reimbursement and billing, we encourage you to apply!
