Pharmacy Claims Reconciliation 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

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Viewing: Pharmacy Claims Reconciliation Specialist - CPhT Preferred

• Make a difference every day in the lives of the underserved
• Join a mission driven organization with a people first culture
• Excellent career growth opportunities

Join us and find a career that supports:

• Caring for overlooked, underserved, and vulnerable patients
• Diversity, equity, inclusion, and belonging
• Autonomy in a warm team environment
• Growth and training

Perks and Benefits

In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including:

• DailyPay, receive your money as you earn it!
• Tuition Assistance and dependent Scholarships
• Employee Assistance Program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax free Health Spending Accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans

*Eligibility for perks and benefits varies based on employee type and length of service.

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan.

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Pharmacy Claims Reconciliation Specialist is responsible for reconciling pharmacy claims and insurance payments to ensure reimbursement accuracy and resolve billing discrepancies. This role serves as a key liaison between pharmacy, finance, and operational teams by validating claim adjudication, researching payment variances, and maintaining the integrity of reimbursement data. The position supports revenue cycle activities through detailed analysis of claims, payments, denials, and reimbursement trends. The Pharmacy Claims Reconciliation Specialist also helps improve processes, ensure compliance, and support accurate financial reporting.

Key Responsibilities

• Reconcile pharmacy claims and insurance payments by comparing expected reimbursements to actual payments and identifying discrepancies such as underpayments, overpayments, duplicate payments, and missing payments.
• 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.

Qualifications & Requirements

1. Education

• 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 a related field is a plus.

1. Experience

• 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.

1. Licenses/Certifications

• None required.

Certified Pharmacy Technician (CPhT) is preferred

We are an Equal Employment Opportunity/Affirmative Action Employer

We celebrate diversity and are committed to creating an inclusive environment for all employees.