Pharmacy Reimbursement & Adjudication Specialist

Absolute Health Care; Massillon (OH); Hybrid; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical and dental insurance

Paid time off and holidays

Shift differential after 5pm

Job summary

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.

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.

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.

Skills

Attention to detail

Organizational skills

Excellent communication

Multitasking

Self-motivation

Microsoft Word

Microsoft Excel

Education

State registration

Pharmacy Technician Certification within 1 year

Tools

Microsoft Word

Microsoft Excel

Job description

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.