Pharmacy Claims Integrity Specialist

Wellpath / Correct Care Solutions; Franklin (TN); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

DailyPay

Tuition Assistance

Employee Assistance Program (EAP)

Company paid life insurance

Health Savings Account (HSA)

Job summary

Wellpath seeks a Pharmacy Claims Reconciliation Specialist to reconcile pharmacy claims and insurance payments, ensuring accurate reimbursement and resolving billing discrepancies. CPhT preferred, with 2–4 years in pharmacy billing or revenue cycle.

The role collaborates with pharmacy, finance, and operations to analyze denials, track trends, and support month-end close. Strong attention to detail and knowledge of Medicaid/Medicare a plus; on-site position in Franklin, TN.

Qualifications

• 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 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.

Responsibilities

• Reconcile pharmacy claims and insurance payments by comparing expected reimbursements to actual payments and identifying discrepancies.
• Research and analyze claim denials, payment variances, and reimbursement trends to determine root causes and recommend corrective actions.
• Coordinate with pharmacy providers and other stakeholders to investigate and resolve payment discrepancies and outstanding billing issues.
• Support revenue cycle operations through claims reconciliation, reimbursement validation, month-end activities, audit documentation, and payment file reviews.
• Generate reports on reimbursement performance, denial trends, recovery opportunities, and payment activity while identifying process improvement and automation opportunities.

Skills

Pharmacy billing

Claims reconciliation

Revenue cycle

Data analysis

Education

High school diploma or equivalent

Certified Pharmacy Technician (CPhT) preferred

Associate degree in Healthcare Administration, Business, Accounting, Finance, Pharmacy Billing, or related field a plus

Job description

Wellpath seeks a Pharmacy Claims Reconciliation Specialist to reconcile pharmacy claims and insurance payments, ensuring accurate reimbursement and resolving billing discrepancies. CPhT preferred, with 2–4 years in pharmacy billing or revenue cycle.

The role collaborates with pharmacy, finance, and operations to analyze denials, track trends, and support month-end close. Strong attention to detail and knowledge of Medicaid/Medicare a plus; on-site position in Franklin, TN.