MAC Reimbursement Specialist

Polaris Pharmacy Services; Fort Lauderdale (FL); On-site; USD 48,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Dental/Vision

401(k)

Life insurance

Disability insurance

Tuition reimbursement

PTO

Performance raises

Career growth

Flu vaccines

Referral bonus

Job summary

Polaris Pharmacy Services in Ft Lauderdale, FL, seeks a MAC Appeals Specialist to manage MAC pricing and under-reimbursement appeals with PBMs. You will compile evidence, communicate with provider relations teams, and drive reimbursement recovery. The role requires attention to detail, strong documentation, and the ability to work across multiple PBM contracts. Experience with NDC, NCPDP formats, and Excel is valued.

Qualifications

• High school diploma or GED is required; an Associate's or Bachelor's degree is preferred.
• Certified Pharmacy Technician (CPhT) license is preferred.
• Knowledge of NDC and NCPDP claim formats and PBM adjudication processes.
• Familiarity with MAC pricing, AWP/WAC benchmarks, and PBM reimbursement.
• Proficient in Excel and handling claims data.
• Strong written and verbal communication for audit rebuttals.

Responsibilities

• Monitor claims data to identify MAC underpayment.
• Assemble MAC appeal packages with invoices and NADAC evidence.
• Submit MAC appeals to PBMs in required formats.
• Track status and follow up on pending requests.
• Analyze outcomes to flag drugs with chronic underpayment.
• Coordinate with PBM provider relations to update MAC pricing.
• Report recovery results and audit risk to leadership.
• Assist data collection for PBM audits within mandated timelines.
• Stay updated on PBM provider manuals and deadlines.

Skills

Attention to detail

Excellent communication

Organizational skills

MAC pricing knowledge

NDC / NCPDP knowledge

Excel proficiency

PBM/audit experience

CPhT license preferred

Education

HS diploma or GED (required); associate/bachelor preferred

Job description

Polaris Pharmacy Services in Ft Lauderdale, FL, seeks a MAC Appeals Specialist to manage MAC pricing and under-reimbursement appeals with PBMs. You will compile evidence, communicate with provider relations teams, and drive reimbursement recovery. The role requires attention to detail, strong documentation, and the ability to work across multiple PBM contracts. Experience with NDC, NCPDP formats, and Excel is valued.