Pharmacy Claims Reconciliation Specialist

About the role

Join a mission-driven organization with a people-first culture that offers excellent career growth opportunities. We see hundreds of thousands of unique individuals each month and provide direct clinical care, including saving lives with Narcan. Our team members undergo continuous training and have access to top-notch clinical resources.

Responsibilities

• Reconcile pharmacy claims and insurance payments to ensure reimbursement accuracy and resolve billing discrepancies.
• Serve as a key liaison between pharmacy, finance, and operational teams by validating claim adjudication, researching payment variances, and maintaining the integrity of reimbursement data.
• Support revenue cycle activities through detailed analysis of claims, payments, denials, and reimbursement trends.
• Help improve processes, ensure compliance, and support accurate financial reporting.
• Generate reports on reimbursement performance, denial trends, recovery opportunities, and payment activity while identifying process improvement and automation opportunities.

Requirements

• High school diploma or equivalent required.
• Experience as a Certified Pharmacy Technician (CPhT) preferred.
• Associate degree in Healthcare Administration, Business, Accounting, Finance, Pharmacy Billing, or a related field is a plus.
• Two to four years of experience in pharmacy billing, claims processing, revenue cycle, payment posting, or insurance reconciliation.
• Experience reconciling pharmacy claims preferred.
• Experience with Medicaid, Medicare, and commercial insurance plans.
• Pharmacy claims reconciliation experience is highly desirable.

Qualifications

• Education: High school diploma or equivalent required.
• Licenses/Certifications: None required.

Benefits

• Comprehensive benefits including medical, dental, vision, paid time off, and 401k.
• DailyPay, receiving your money as you earn it!
• Tuition Assistance and dependent Scholarships.
• Employee Assistance Program (EAP) including free counseling and health coaching.
• Company-paid life insurance.
• Tax-free Health Spending Accounts (HSA).
• Wellness program featuring fitness memberships and product discounts.
• PREFERRED banking partnership and discounted rates for home and auto loans.
• Discounted rates for home and auto loans.

Why Us

Now is your moment to make a difference in the lives of the underserved. We believe in the power of serving others and providing quality care to every patient with compassion, collaboration, and innovation. We strive to live our mantra to "Always Do The Right Thing!" and support the healing of the world, one patient at a time. We offer ongoing training and development opportunities for our healthcare team members and have best-in-class clinical resources for training, education, and point-of-care support.