Pharmacy Reimbursement & Adjudication Specialist

Pharmacy Adjudication / Reimbursement Specialist

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.

• Flexible scheduling
• Afternoon shift
• Rotating weekends

• 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

• 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

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.

• 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!