Pharmacy Adjudication/Reimbursement Specialist - Immediate Opening

Absolute Health Care; Massillon (OH); Hybrid; USD 42.000 - 54.000; Vollzeit

Benefits dieser Stelle

Medical and dental insurance

Paid time off and holidays

Shift differential after 5pm

Zusammenfassung

Absolute Health Care in Massillon, OH is seeking a Pharmacy Adjudication / Reimbursement Specialist to join our long‑term care pharmacy team. You will verify patient and insurance information and submit electronic claims to payers, ensuring accurate billing and compliance with payer regulations.

The role emphasizes attention to detail and timely processing in a fast-paced environment, with a full-time schedule and remote options for Sundays and certain shifts.

Qualifikationen

• 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.

Aufgaben

• Verify patient demographics and insurance information for accuracy.
• Submission of claims to Insurance Companies electronically.
• 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.
• Investigate and resolve insurance and Medicaid rejections.
• Maintain accurate documentation of all billing activities.
• Perform other duties as assigned.

Kenntnisse

Attention to detail

Organizational skills

Excellent communication

Multitasking

Self-motivation

Microsoft Word

Microsoft Excel

Ausbildung

State registration

Pharmacy Technician Certification within 1 year

Tools

Microsoft Word

Microsoft Excel

Jobbeschreibung

Pharmacy Adjudication / Reimbursement In Office Specialist

Position Summary

We are seeking a detail-oriented and motivated Pharmacy Adjudication / Reimbursement Specialist to join our Long Term Care Pharmacy 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.

Benefits

• Benefit Package includes comprehensive medical, dental insurance along with earned Paid Time off and Holidays. Shift differential after 5pm additional wage added.

Schedule

• Full-Time Position
• Shift available: 1:00pm-9:30pm non remote
• Sundays Half shift 7pm-11pm remote
• Saturdays 1 every 3 -4 weeks 9am-5:30pm remote

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

Key Responsibilities

• Verify patient demographics and insurance information for accuracy
• Submission of claims to Insurance Companies electronically
• 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
• Investigate and resolve insurance and Medicaid rejections
• 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