Pharmacy Adjudication/Reimbursement Specialist - Immediate Opening

Absolute Health Care; North Canton (OH); Hybrid; USD 35,000 - 52,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Paid time off

Holidays

Shift differential after 5pm

Job summary

Absolute Health Care in North Canton, OH is seeking a Pharmacy Adjudication / Reimbursement Specialist to join our Long Term Care Pharmacy team. You will verify patient demographics and insurance information, submit claims electronically, and manage prior authorizations in a fast-paced environment.

This is a full-time in-office role with benefit package, including medical and dental insurance, earned Paid Time Off and Holidays.

Qualifications

• Detail-oriented with strong organizational skills.
• Excellent written and verbal communication abilities.
• Ability to multitask and manage competing priorities.
• Pharmacy Technician Certification within 1 year of hire.
• State registration required.

Responsibilities

• Verify patient demographics and insurance information for accuracy.
• Submit 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.

Skills

Attention to detail

Organizational skills

Verbal communication

Written communication

Multitasking

Independent worker

Education

Pharmacy Technician Certification

State registration

Tools

Microsoft Word

Microsoft Excel

Job description

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 in North Canton Office. 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.

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's 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