Reimbursement Analyst

Job Summary

To ensure accurate financial integrity of pharmacy claims, the full-time remote Reimbursement Analyst will manage claims reconciliation, denial management, and reimbursement monitoring across various payer channels including Medicare and commercial insurance.

Key responsibilities

• Perform end-to-end reconciliation of third-party pharmacy claims and resolve payment discrepancies
• Analyze claim denials and initiate timely appeals while tracking denial trends
• Monitor actual reimbursement against expected contract rates and maintain reconciliation logs for audit readiness

Required qualifications

• 3+ years of experience in pharmacy billing, claims reconciliation, or pharmacy revenue cycle operations
• Demonstrated knowledge of Medicare Part B and/or Part D billing and reimbursement workflows
• Hands-on experience with commercial insurance and PBM claim adjudication, denials, and appeals
• Strong familiarity with ERA/EOB interpretation and accounts receivable follow-up processes
• Understanding of HIPAA, CMS coverage guidelines, and pharmacy compliance requirements