Reimbursement and Contract Analyst

Gifthealth

Reimbursement and Contract Analyst at Gifthealth, overseeing pharmacy claims reconciliation and reimbursement processes. Focusing on analytical and financial integrity across various payer channels.

Posted 5/26/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $80,000 - $100,000 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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.

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work hours
Paid time off
Remote work options

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims reconciliationpharmacy billingMedicare Part BMedicare Part Dcommercial insurancePBM claim adjudicationERA interpretationEOB interpretationAR follow-up processesreimbursement workflows

Soft Skills

attention to detailability to manage large claim volumescommunicationproblem-solvingcollaboration