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How much do pharmacy benefit coder jobs pay per hour?

As of May 28, 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 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 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.

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.

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.

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
Senior Pharmacy Benefit Verification Specialist

Senior Pharmacy Benefit Verification Specialist

Onco360

New Hyde Park, NY • On-site

$30/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Senior Pharmacy Benefit Verification Specialist for our Pharmacy located in New Hyde Park, NY. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Current shift available: 10:30am-7:00pm EST
**Starting salary at $30/HR and up**
We offer a great benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Senior Pharmacy Benefit Verification Specialist Major Responsibilities:
The Senior Benefit Verification Specialist will work closely with the Senior Manager, Patient Benefits to ensure completion of challenging cases and escalations in their designated vertical. Senior Benefits Verification Specialists 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. They may also assist with training employees, and other duties as assigned.
  • Works and resolve difficult or escalated cases to assist in processing prescription orders
  • Participates in the orientation and training of benefit verification specialists within workflow vertical
  • Escalates workflow/process improvement ideas to leadership
  • 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.
Senior Pharmacy Benefit Verification Specialist Qualifications:
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
    • Desired: Associates or Bachelor’s Degree, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
  • Work Experience
    • Required: 2+ 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.
      Desired: Specialty pharmacy experience, leadership skills
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • 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 skills

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