Pharmacy Reimbursement Specialist - Pediatric Outpatient
On-site · Nashville, Tennessee, United States
Job Summary
Pharmacy Reimbursement Specialist responsible for evaluating reimbursement of medications for inpatients, clinic patients, and outpatient prescriptions. Works with multidisciplinary teams to develop procedures and programs to maximize reimbursement, troubleshoot issues with medication claims in the OP dispensing system, and edit/submitting claims when needed. Rotates between daily pharmacy operations and decentralized location duties, communicates with patients and families about prescriptions, coordinates delivery, and collaborates with nurses, residents, and physicians regarding medications, discharge timing, and challenges. Produces monthly written updates on activities and financial impact, analyzes denials/underpayments, and helps identify opportunities to improve reimbursement. Maintains data in appropriate databases, supports regulatory compliance (JCAHO, ASHP, state/federal regulations, Leapfrog), and participates in ongoing education to enhance reimbursement strategies. The role includes cross-functional collaboration with pharmacy, finance, contracts, and patient accounting to optimize reimbursement and reduce losses, with an emphasis on data-driven decision making and program development. Location: Monroe Carell Jr. Outpatient Hospital, Nashville, TN; hours Monday–Friday, 8-hour daytime shifts.
Required Qualifications
- 2 years relevant work experience
- PTCB/NHA National Pharmacy Technician Certification required
- Tennessee Board of Pharmacy Technician Registration must be obtained within 90 days of employment
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.