Pharmacy Billing Dispute & Resolution Specialist

MedWiz Mgmt LLC; Cherry Hill Township (NJ); On-site; USD 42,000 - 65,000; Full time

Job summary

MedWiz Mgmt LLC is seeking a Pharmacy Billing Dispute & Resolution Specialist in New Jersey to research and resolve billing discrepancies across dispensing, deliveries and payer information. The role partners with Billing and Pharmacy Operations to validate charges and determine appropriate credits or corrections.

Ideal candidates will have a high school diploma with 2+ years in pharmacy billing or related healthcare roles, plus strong analytical, Excel, and communication skills.

Qualifications

• High school diploma or GED required; 2+ years in pharmacy operations, PBM billing, or related healthcare environment.
• Pharmacy technician registration or licensure where required by state law.
• Strong analytical, investigative, organizational, and problem‑solving skills with ability to research and reconcile discrepancies.
• Intermediate proficiency with Microsoft Excel and healthcare systems used for billing and medication distribution.
• Ability to read medication documentation, reports, and communicate findings clearly.

Responsibilities

• Review and resolve customer billing audits, disputes, account discrepancies, and credit requests.
• Research dispensing records, deliveries, returns, census activity, payer information, and operational documentation.
• Determine whether disputed charges are supported and identify credits, adjustments, rebills, or corrections.
• Identify root causes of billing discrepancies and recurring trends.
• Maintain clear, accurate documentation supporting findings and resolutions.
• Collaborate with Billing, Pharmacy Operations, Customer Service, Finance, and facility reps to resolve issues.
• Track open billing issues through completion and follow up.
• Escalate high-dollar or unresolved discrepancies to management.
• Suggest process, system, or training improvements to reduce billing issues.
• Maintain confidentiality and HIPAA compliance.

Skills

Analytical skills

Investigative mindset

Organizational skills

Problem solving

Communication skills

Education

High school diploma or GED

Associate degree preferred

Certified Pharmacy Technician (CPhT)

Tools

Microsoft Excel

Pharmacy billing systems

Job description

Description

The Pharmacy Billing Dispute & Resolution Specialist researches and resolves c corrective action, and ensure resolutions are supported by accurate documentation. This position reviews dispensing activity, delivery records, returns, credits, census changes, medication changes, payer information, facility communications, and other relevant records to identify the root cause of billing discrepancies and help prevent recurring issues.ustomer billing inquiries, audits, disputes, invoice discrepancies, credit requests, and related account issues. The role serves as a liaison between Billing and Pharmacy Operations to determine what occurred operationally, validate charges, identify appropriate

Job Responsibilities

• Review and resolve customer billing audits, disputes, account discrepancies, and credit requests.
• Research dispensing records, deliveries, returns, credits, census activity, payer information, and other operational documentation.
• Determine whether disputed charges are supported and identify appropriate credits, adjustments, rebills, or corrections.
• Identify the operational root cause of billing discrepancies and recurring trends.
• Maintain clear and accurate documentation supporting findings and resolutions.
• Partner with Billing, Pharmacy Operations, Customer Service, Finance, and facility representatives to resolve issues.
• Track open billing issues and audits through completion and follow up on outstanding items.
• Escalate high-dollar, recurring, unusual, or unresolved discrepancies to management.
• Recommend process, system, or training improvements that may reduce repeat billing issues.
• Maintain confidentiality and comply with applicable pharmacy, billing, HIPAA, and company requirements.
• Maintain predictable, reliable, and punctual attendance and perform other related duties as assigned.

Requirements

Basic Qualifications

• High school diploma or GED and at least 2 years of related experience in pharmacy operations, pharmacy or PBM billing, accounts receivable, customer account management, or a related healthcare environment; equivalent education and experience considered.
• Pharmacy technician registration or licensure where required by state law or assigned responsibilities.
• Strong analytical, investigative, organizational, and problem-solving skills, with the ability to independently research, reconcile, and resolve recurring billing discrepancies.
• Intermediate proficiency with Microsoft Excel and pharmacy, billing, medication distribution, or related healthcare systems.
• Ability to read and interpret medication documentation, reports, business correspondence, and procedures and communicate findings effectively in writing and verbally.
• Ability to perform basic calculations involving rates, ratios, percentages, decimals, and account balances and interpret reports, charts, and data.

Preferred Qualifications

• Associate degree, bachelor’s degree, or relevant technical or pharmacy credential.
• Certified Pharmacy Technician (CPhT).
• Long-term care or closed-door pharmacy experience.
• Experience with pharmacy claims, credits, audits, billing resolution, or long-term care pharmacy software.