Pharmacy Reimbursement Administrator

Job Summary

Working remotely in a full-time capacity, the Pharmacy Reimbursement Administrator will manage pharmacy remittances, oversee claims adjudication processes, and ensure compliance with pharmacy contract agreements.

Key responsibilities

• Administers technical processes for system price setups, electronic funds transfers, and remittance setups
• Ensures oversight and reporting on the end-to-end process, identifying and implementing necessary controls
• Conducts pharmacy network rate testing and quality assurance to mitigate incorrect claims adjudication

Required qualifications

• Associate Degree preferred or equivalent experience; CPhT preferred
• Experience in PBM or managed care is preferred but not required
• Previous testing experience is preferred
• Ability to support compliance program objectives
• Demonstrated cooperative and respectful interaction with other employees