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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 Jul 20, 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. These roles typically require certification and familiarity with coding systems like ICD-10 and CPT, and they often offer flexible schedules and remote work options. Job prospects remain favorable for those with relevant skills and certifications.

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?

In the pharmacy benefit coding field, CCS (Certified Coding Specialist) typically offers higher salaries than CPC (Certified Professional Coder) due to its specialized focus on pharmacy and healthcare coding. CCS credential holders often have more advanced skills and may work in more complex environments, which can lead to higher pay. However, salaries vary based on experience, location, and employer.

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 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.

Will AI eventually replace medical coders?

Pharmacy benefit coders play a crucial role in translating medical and pharmacy data into codes for billing and insurance purposes. While AI and automation tools are increasingly used to assist with coding tasks, human oversight remains essential to ensure accuracy and handle complex cases. Therefore, AI is likely to augment rather than fully replace pharmacy benefit coders in the foreseeable future.

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 practice help develop proficiency, and certifications like CPC can improve skills. The job often involves working with electronic health records and coding software in a structured environment.
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 Coordinator

Pharmacy Benefit Coordinator

Maryland Physicians Care

Linthicum, MD • On-site, Remote

$67K - $72K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Job description

Job Type
Full-time
Description
Summary:
The Pharmacy Benefit Coordinator is responsible for supporting clinical outreach services to our members, their pharmacies, and their healthcare providers to ensure member safety, minimize gaps in care, identify cost-effective medication strategies, and coordinate care to improve healthcare outcomes for our members. The position will support HEDIS adherence initiatives and work to support longitudinal improvement goals.
In addition, the Pharmacy Benefit Coordinator performs a variety of routine to moderately complex administrative and pharmacy-related tasks that support the Pharmacy Management team within the department. The Pharmacy Management team is responsible for managing the pharmacy benefits for Maryland Physicians Care in collaboration with the pharmacy benefit management (PBM) vendor and the organization's utilization review, quality improvement, provider relations, and population health initiatives.
About Maryland Care Management, Inc. (MCMI)
Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.
Why join us?
MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.
Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to impact our members' lives positively.
What You'll Do:
  • Work collaboratively with quality management to support HEDIS adherence projects.
  • Support the accurate implementation and coding of pharmacy benefits, formulary, and program changes, including review of PBM testing scenarios.
  • Review pharmacy services recommended for denial. Of those recommendations, investigate and review data and information retrieved from plan providers.
  • Assist in the management of members by collecting pertinent information from plan providers and other pharmacy data systems.
  • Assist in various pharmacy, utilization review/management, quality improvement, provider relations, and population health initiatives.
  • Serve as a pharmacy liaison and resource person to plan pharmacies and members.
  • Assist the Pharmacist with monitoring and evaluation of pharmacy utilization.

Requirements
Knowledge and Skills:
  • Thorough understanding of prescription benefit management (PBM) programs and practices.
  • Ability to identify, communicate findings, and resolve member, provider, process, and system issues, communicating recommendations verbally and in writing.
  • Business writing and presentation skills, including writing reports.
  • Excellent attention to detail, including but not limited to interpretation and understanding of benefits/codes.
  • Familiarity with government relations and the ability to operationalize and understand how various aspects of regulation are interdependent and related.
Education and Work Experience:
  • High School diploma/ GED, or equivalent.
  • Current Maryland State Pharmacy Technician licensure, including certification from a nationally recognized Pharmacy Technician Certification Board.
  • Minimum two (2) years of experience as a pharmacy technician.
  • Experience working in a managed care, insurance, PBM, or equivalent environment is strongly preferred.
  • Experience supporting utilization management/prior authorization processes.

EEOC Statement: Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment. As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive. We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.
Salary Description
$67-72k

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