About this role

Perform end-to-end reconciliation of third party pharmacy claims across Medicare Part B and D, Medicaid, commercial insurers, and PBMs
Analyze claim denials and rejections by payer, denial code, and drug category
Monitor actual reimbursement against expected contract rates for each payer
Manage outstanding AR aging by payer, prioritizing high-dollar claims
Serve as a point of contact for payer portals, provider relations representatives, and clearinghouse inquiries
Ensure all reconciliation activities adhere to CMS guidelines, HIPAA requirements, and internal audit protocols
Work closely with pharmacy operations, finance, and technology teams to surface workflow inefficiencies

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 AR follow-up processes
Understanding of HIPAA, CMS coverage guidelines, and pharmacy compliance requirements
High attention to detail and ability to manage large claim volumes without sacrificing accuracy.

Reimbursement and Contract Analyst

Key skills