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Pharmacy Benefit Coder Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$24/hr

Conducts job responsibilities in accordance with the standards set out in the Company's Code of ... Pharmacy Benefit Verification Specialist Qualifications: * Education/Learning Experience * Required:

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How much do pharmacy benefit coder jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for pharmacy benefit coder in the United States is $19.27, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $20.43 per hour, depending on experience, location, and employer.

What are some common challenges Pharmacy Benefit Coders face when interpreting complex insurance policies?

Pharmacy Benefit Coders often encounter challenges when interpreting the nuances of various insurance policies, particularly as formularies, coverage tiers, and reimbursement rules can frequently change. Keeping up-to-date with these policy updates and accurately translating them into coding systems requires attention to detail and strong analytical skills. Additionally, coders must collaborate closely with pharmacists and insurance specialists to clarify ambiguities and ensure accurate claims processing, which can be demanding in a fast-paced environment.

Is medical billing and coding worth it in 2026?

Pharmacy benefit coders and medical billing and coding professionals are expected to see steady demand through 2026 due to ongoing healthcare industry needs. The role requires attention to detail, familiarity with coding systems like ICD and CPT, and often certification, making it a viable career choice for those seeking stable employment in healthcare administration.

What is the difference between Pharmacy Benefit Coder vs Pharmacy Technician?

AspectPharmacy Benefit CoderPharmacy Technician
CredentialsCertification in coding or pharmacy benefit managementCertification or registration with pharmacy boards often required
Work EnvironmentInsurance companies, pharmacy benefit management firmsRetail pharmacies, hospitals, clinics
Job FocusAnalyzing and coding pharmacy benefit claims, ensuring proper reimbursementDispensing medications, assisting pharmacists, managing prescriptions

The main difference is that Pharmacy Benefit Coders focus on analyzing and coding pharmacy benefit claims for insurance reimbursement, while Pharmacy Technicians assist pharmacists with dispensing medications and managing prescriptions. Both roles require relevant certifications and are integral to pharmacy operations, but they serve distinct functions within the healthcare and pharmacy industry.

What pays more, CCS or CPC?

For pharmacy benefit coders, Certified Coding Specialist (CCS) and Certified Professional Coder (CPC) certifications can influence salary, but generally, CCS certification tends to offer higher pay due to its focus on hospital and inpatient coding, which are often higher-paying roles. Both certifications require strong knowledge of medical coding, but CCS is more specialized and may lead to higher salaries in certain healthcare settings.

What are the key skills and qualifications needed to thrive as a Pharmacy Benefit Coder, and why are they important?

To thrive as a Pharmacy Benefit Coder, you need a strong understanding of pharmacy benefit management, medical coding, and insurance processes, often supported by certification such as CPC or CPhT. Familiarity with pharmacy billing software, coding systems like ICD-10 and CPT, and claims processing tools is typically required. Strong attention to detail, analytical thinking, and effective communication skills help ensure accuracy and collaboration with healthcare teams. These skills are crucial for minimizing claim errors, ensuring regulatory compliance, and optimizing reimbursement for pharmacy services.

What is the highest paid medical coder?

The highest paid medical coders are often those specializing in inpatient hospital coding, such as Certified Inpatient Coder (CIC) or Certified Professional Coder-Hospital (CPC-H), with salaries exceeding $70,000 annually. Experience, certifications, and working in specialized or high-demand areas can lead to higher compensation in medical coding roles.

What are Pharmacy Benefit Coders?

Pharmacy Benefit Coders are professionals responsible for translating prescription drug information into standardized codes used for processing pharmacy claims and ensuring proper medication coverage under health insurance plans. They work closely with pharmacists, insurance companies, and healthcare providers to ensure accurate reimbursement and compliance with regulatory guidelines. Their role is crucial in managing formularies, resolving claim issues, and optimizing the efficiency of pharmacy benefit management.

Is ICD coding difficult?

ICD coding for a Pharmacy Benefit Coder involves understanding medical diagnoses and applying standardized codes, which requires attention to detail and familiarity with coding guidelines. While it can be complex initially, training and experience help improve accuracy and efficiency in the role.
More about Pharmacy Benefit Coder jobs
What states have the most Pharmacy Benefit Coder jobs? States with the most job openings for Pharmacy Benefit Coder jobs include:
What job categories do people searching Pharmacy Benefit Coder jobs look for? The top searched job categories for Pharmacy Benefit Coder jobs are:
Pharmacy Benefit Coder jobs near you
Pharmacy Benefit Verification Specialist

Pharmacy Benefit Verification Specialist

CareMed Specialty Pharmacy

Woodridge, IL • On-site, Remote

$24/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

Key responsibilities

  • Investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, and assign coordination of benefits.

  • Run test claims to obtain valid insurance responses on patient medications and document benefit outcomes in the CPR+ system.

  • Provide thorough, accurate, and timely responses to requests from pharmacy operations, providers, and patients regarding benefit information.

Job description

Are you someone looking for professional career growth? CareMed Pharmacy is looking for Pharmacy Benefit Verification Specialists for our growing Pharmacy!
Work Hours: Monday-Friday shifts available; some weekends as needed. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.
**Starting salary at $24.00/hr and up** We also offer quarterly incentive bonuses.
Sign-On Bonus: $5,000 for employees starting before July 31, 2026.
We offer a variety of benefits including:
  • Medical, Dental amp; Vision insurance
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Paid Volunteer Day
  • Floating Holiday
  • Referral Incentive
  • Paid Life, and short amp; long-term disability insurance
Pharmacy Benefit Verification Specialist Summary:
The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.
Pharmacy Benefit Verification Specialist Major Responsibilities:
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.
  • Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
  • Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Benefit Verification Specialist Qualifications:
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
  • Work Experience
    • Required: 1+ years pharmacy or benefit verification experience
    • Desired: 3+ years pharmacy or benefit verification experience
  • Skills/Knowledge:
    • Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skill
Here at CareMed, our patients are important to us, so we always strive to meet and exceed their needs. We are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.

Apply