Payer Accounts Specialist

Job Description

Job Description

Education / Licensing Requirements: 

• High school diploma or GED; pharmacy technician registration or certification when required by applicable law or assigned duties is required
• PTCB certification; coursework in pharmacy, healthcare administration, or business is preferred.

Experience Requirements:

• 1–2 years of specialty pharmacy, pharmacy operations, payer support, patient services, or related experience is required.
• Experience researching pharmacy claim rejections, payer/PBM inquiries, copay assistance, member onboarding, or account administration is preferred.

Position Overview :

The Payer Accounts Specialist supports day-to-day payer and pharmacy benefit manager (PBM) account operations by responding to inquiries, coordinating resolution of prescription access and claims issues, and supporting member onboarding and payer implementations. The position maintains accurate account records, facilitates timely communication across operational teams, and escalates complex contractual, financial, and reporting matters to the Payer Operations & Audits Manager or designated owners.

Positions reporting to this position: None

Essential Skills:

• Strong written and verbal communication skills 
• Works well in team environment 
• Proven time management and organizational skills 
• Strong analytical skills 
• Proven ability to prioritize and multi-task 

Characteristics:

• Self-directed 
• Flexible and proactive 
• Sense of urgency 
• Detail oriented; catches errors early 
• Ethical; respects confidentiality

Responsibilities:

• Serve as an operational point of contact for routine payer/PBM inquiries; research service concerns, document findings, coordinate responses, and escalate unresolved or high-risk issues.
• Investigate prescription claim rejections, benefit and eligibility questions, copay enrollment or processing issues, and reimbursement discrepancies; work with Pharmacy Operations, Finance, and other teams to resolve or route appropriately.
• Support payer account administration by maintaining current contacts, plan identifiers (BIN/PCN/group), drug access requests, account changes, case notes, and issue-resolution trackers; verify accuracy of submitted information.
• Assist with payer and program implementations, member onboarding, drug additions, and operational readiness; monitor assigned tasks, communicate status, and identify barriers requiring management attention.

Key Deliverables & Performance Expectations

• Routine payer inquiries and service issues acknowledged, documented, and resolved or escalated within established expectations. 
• Claim rejection, reimbursement, drug access, and copay issues tracked with clear ownership and follow-up. 
• Payer account records, plan identifiers, and operational trackers maintained accurately and promptly. 
• Assigned onboarding and implementation tasks completed by agreed milestones. 
• Requested account information and source documentation provided to reporting, audit, and management teams accurately and on time. 
• Specific targets and service standards to be approved by management.

Working Conditions: 

• Fast-paced environment.
• Requires normal vision (corrected) both close and distant.
• Requires normal hearing levels (corrected).
• Requires working at a desk to use a phone and computer for extended periods of time. Requires sitting, bending.
• Uses office equipment and machinery effectively.
• Requires normal finger dexterity for keyboarding.
• Works effectively with frequent interruptions.
• Minimal travel <5%.