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 electronic funds transfer and remittance setups according to policy
• Ensures oversight reporting and process controls for claims adjudication accuracy and compliance
• Conducts pharmacy network rate testing and analysis to identify pricing setup issues and implement resolutions

Required qualifications

• Associate Degree preferred or equivalent experience; CPhT certification preferred
• Experience in PBM or managed care preferred, but not required
• Previous testing experience is preferred
• Ability to participate in and support compliance program objectives
• Strong interpersonal skills to interact cooperatively with team members