Pharmacy Claims Technician (Internal)
$37,440–$45,760 year
On-site · Grand Rapids, Michigan, United States
Job Summary
Pharmacy Claims Technician responsible for processing and submitting daily prescription claims in real time, monitoring and clearing billing queues, managing recurring billing cycles for long-term care patients, handling bulk claims tied to cycle-fill schedules, creating and reviewing billing batches, resolving batch exceptions and claim rejections, navigating prior authorization with providers and payers, updating records for admissions, discharges, or insurance changes, prioritizing first-dose and urgent claims, and collaborating with the pharmacy team on time-sensitive issues. Requires High School Diploma or equivalent, Michigan Pharmacy Technician License, 1-2 years of pharmacy billing/claims experience, familiarity with FrameworkLTC or QS/1, knowledge of Medicaid/Medicare Part D and private insurance, strong problem-solving, attention to detail, and commitment to patient confidentiality.
Required Qualifications
- High School Diploma or equivalent
- Michigan Pharmacy Technician License (required)
- 1-2 years of pharmacy billing or healthcare claims processing experience
- Experience with the pharmacy billing platforms like FrameworkLTC or QS/1
- Solid understanding of Medicaid, Medicare Part D, and private insurance
- Strong problem-solving ability when it comes to claim rejections and PA issues
- Excellent attention to detail, communication, and time management
- A commitment to patient confidentiality
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