Pharmacy Technician Insurance Specialist

NHS Management, LLC; Northport (AL); On-site; USD 40,000 - 55,000; Full time

Job summary

NHS Management, LLC is seeking a Pharmacy Admin Specialist to bridge pharmacy knowledge with payer negotiations and plan coverage for residents. You will advise on PDP options, enroll for subsidies when applicable, and coordinate with facilities to resolve coverage issues.

The role emphasizes compliance, training of staff, and effective communication with administrators, physicians, and insurance plans to ensure timely billing and paid claims.

Qualifications

• Knowledge of Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third Party Insurances.
• Strong organization skills and ability to manage multiple tasks in a dynamic environment.
• Strong written and oral communication skills.
• Knowledge of office machines and equipment.
• Basic computer skills; experience with Excel and Word.
• Ability to make independent decisions.

Responsibilities

• Resolve rejections, denials and PA’s for Medicaid, Medicare D or Private Insurance claims.
• Serve as liaison with Administrators, DONs, Admissions, Social Services and PDP/insurance plans.
• Advise residents and parties on PDP options and subsidy eligibility.
• Provide daily/weekly communications with facilities about coverage issues and resolutions.
• Ensure compliance with internal controls and regulations; participate in plan improvements.
• Provide training to staff to support job performance and cross-functional awareness.

Skills

Organization

Analytical

Communication

Decision making

Teamwork

Pressure handling

Education

High school diploma

Tools

Microsoft Excel

Microsoft Word

Job description

JOB DETAILS
Are you a Pharmacy Tech looking to make the jump into the administrative side of the business? If so, here is your opportunity.
Working with us means being part of something special: A team that is passionate about making an impact on our patients’ lives each and every day. Unlike the typical hospital setting, our facility offers you the unique opportunity to walk alongside patients on their road to recovery from many different conditions. As you care for and help patients achieve goals and regain independence, you can form significant relationships with them and celebrate the successes they experience along the way.

GENERAL PURPOSE

To provide knowledge of Medicare, Medicaid, Prescription Drug Plans (PDP’s) and Third Party Insurances to appropriate health care professionals, advising resident and appropriate parties on PDP options available, enrolling and applying for low income subsidy if applicable. Ensures that all adjudicated prescriptions leaving the pharmacy have received a paid response or the claim has been resolved to bill to the next appropriate payor.
Performs and/or oversees the completion of all routine and tasks, including but not limited to:

• Resolution of rejections, denials and PA’s associated with all adjudicated Medicaid, Medicare D or Private Insurance claims.
• Serves as the Communication liaison regarding medication or resident coverage issues with; Administrators, DON’s, Admissions, Social Services, Consultant Pharmacists, Internal Pharmacists, Data Entry, Business Office staff, Resident’s, Responsible Parties, Physicians, Medical Directors and PDP’s/Insurance plans.
• Advises resident and appropriate parties on PDP options available.
• Counsels customers and appropriate parties on enrolling, and applying for low income subsidy if applicable.
• Provides daily and weekly communications with facilities regarding outstanding coverage issues and works to find and assist in resolving coverage issues in a timely manner.
• Accepts ownership and accountability for the successful completion of assigned functions and achievement of goals.
• Strives for compliance by all staff with internal controls and state and federal regulations.
• Participates in the development and successful implementation of plan(s) of improvement as indicated, recommended and/or required by Supervisor, Director, or any other corporate or regulatory compliance consultant. Communicates progress toward goals and ongoing obstacles to supervisor and company management team, verbally and/or in writing or as dictated.
• Provides training to other staff that is necessary to successful job performance, consistent with company standards and expectations, and facilitates cross-functional awareness and proficiencies.

Qualifications

• High school diploma or equivalent.
• Knowledge of Medicare, Medicaid, Prescription Drug Plans (PDP’s) and Third Party Insurances.
• Strong organization skills including the ability to prioritize and manage multiple tasks in a dynamic environment.
• Strong analytical skills; ability to quickly identify problems and find effective solutions
• Strong written and oral communication skills.
• Must have knowledge of office machines and equipment.
• Basic computer skills preferred; experience with Microsoft Excel and Word.
• Ability to make independent decisions.
• Ability to understand and interpret claim information data.
• Ability to work and produce results under pressure
• Ability to effectively and harmoniously interact with facility, management and other employees at all levels; promotes teamwork and professionalism
• Must be capable of maintaining regular attendance
• Must be dependable and able to work with minimal supervision
• Must be at least 18 years of age
• Must be able to speak, read, write, and understand English

Job Ref #: c19f8865-45f4-47d2-96fc-8fe7cd6d2e3b
Date Posted: 2026-07-16