Pharmacy Operations & Claims Specialist na Coborn's

Overview:

Are you a pharmacy professional who has a knack for insurance and compliance? As the Pharmacy Operations and Claims Specialist, you will use your expertise to oversee the accurate processing of insurance claims (including Medicare, Medicaid, and other third-party payors) and maintain payer compliance. Also, you will become an expert in managing our pharmacy invoices while building relationships with our vendors and our Coborn’s Finance Team.

 

At the Coborn’s Support Center, our Pharmacy Team is collaborative and committed to your success! We are excited to help you learn and thrive in this role!

 

Duties Include:

 

Insurance Claims Processing & Compliance

•         Oversee and perform end-to-end claims processing for Medicare, Medicaid, and third-party payers.
•         Verify patient eligibility and prescription benefits; prepare and submit claims within payer timelines.
•         Audit patient files and maintain required documentation for payer compliance and audit readiness.
•         Act as a subject matter expert for claims processing and related compliance inquiries from pharmacy teams.
•         Monitor payer requirement changes and guide field staff on best practices for documentation and compliance.
•         Resolve outstanding claim issues, ensuring timely and accurate submission and follow-up.

Pharmacy Accounts Payable & Receivable Support

•         Manage incoming pharmacy-related invoices to ensure accurate coding, approval, and payment.
•         Collaborate with vendors and internal finance teams to maintain accurate documentation and timely resolution of discrepancies.
•         Respond to internal and external inquiries related to A/P and A/R issues.

Pharmacy Operations & Program Support

•         Provide operational support to pharmacy locations and the internal pharmacy operations team.
•         Support enterprise-level pharmacy systems (e.g., EnterpriseRx) as a first-level resource.
•         Administer and maintain Risk Evaluation and Mitigation Strategy (REMS) programs, including training and  communications.
•         Collaborate with internal teams and vendors to support pharmacy-centric programs and initiatives.
•         Contribute to planning and execution of pharmacy department events and special projects.
• Identify and support process improvement initiatives to enhance compliance, efficiency, and risk mitigation.

Requirements:

Education and Experience

• Bachelor’s degree in healthcare administration, business, or related field preferred; or equivalent experience in pharmacy operations, insurance claims processing, or healthcare billing.
• Prior experience as a pharmacy technician, or in pharmacy operations, medical claims processing, or healthcare compliance preferred.
• Strong working knowledge of Medicare, Medicaid, and commercial pharmacy insurance billing standards and compliance guidelines.

 

Skills, Certifications, & Licensures

 

Job Skill

• Strong working knowledge of Medicare, Medicaid, and commercial pharmacy insurance billing standards and compliance guidelines
• Familiar with general accounting processes. Ability to manage highly sensitive data with integrity and confidentiality.
• Skilled in utilizing online research tools and payer websites to support prescription claims resolution and pharmacy operations.
• Accurate and efficient in data entry, documentation, and system navigation, consistent with the workflow demands of a high-volume pharmacy setting.

We believe that building a team of people with different backgrounds, beliefs, experiences and perspectives inspires fresh thinking and opens us up to new possibilities. We are an EEO/AA Employer - All qualified individuals, including minorities, females, veterans and individuals with disabilities are encouraged to apply.

What's In It For Me:

Our remarkable employees are at the heart of everything we do. At Coborn’s, we’re committed to creating a supportive and rewarding workplace—one that offers a vibrant, team-oriented environment, ongoing career growth, and meaningful benefits. As an employee-owned company, we believe in investing in our people and their futures.

 

We’re proud to offer a variety of benefits to both our full-time and part-time employees, including: 

 

• 10% Employee Discount (for the employee and their immediate household) at our grocery and franchise locations (Ace Hardware, Caribou Coffee, Erbert and Gerbert’s, and Pet Supplies Plus)
• Get Paid Daily with DailyPay – for employees who would like access to their pay before payday, we offer this great benefit!
• Paid Time Off (PTO/Vacation)
• Paid Floating Holidays & 1 - ½ time for hours worked on a company-recognized holiday!
• Paid Military Leave
• Employee Health & Wellness Programs, Challenges and Resources – to assist our team members in living a life of wellbeing!
• Employee Assistance Program (EAP) – unlimited phone access to legal, financial, and work-life services and up to five free in-person counseling sessions, per situation/issue, per year
• Tools, resources and opportunities for career growth and development
• 401(k) plan options – we also match up to 20% of the first 5% contributed
• Participation in our Employee Stock Ownership Program (ESOP) – yes, we’re employee-owned! Our team members benefit from the success of the company through this company-sponsored benefit!
• Additional Voluntary Benefits – such as vision, accident and critical illness insurances

 

If you’re hired or promoted into a full-time position with our company, you will also be eligible for: Medical & Dental Insurance, Health Savings Account (HSA), Flexible Spending Account (FSA), Tuition Reimbursement, Adoption Reimbursement, Paid Family Caregiver Leave, as well as company-sponsored Term Life Insurance, Accidental Death & Dismemberment Insurance, and Short-Term & Long-Term Disability Insurance!

 

As a member of our team, you can also expect:

 

• Flexible scheduling - We understand that many of our employees are trying to juggle school, practice, family time, errands and personal hobbies, all with only about 16 hours of awake time in a day.
• Recognition - We celebrate a culture of recognition, encouraging employees to recognize and thank one another for remarkable behavior. We even have an app for that!
• Growth Opportunities - We're always looking for motivated, high-potential employees who want to be part of our next generation of leaders! There are opportunities to grow within our company to positions you may not yet even know exist. Coborn's, Inc. offers a variety of development programs for employees who want to grow their careers with us. 

 

Our culture celebrates employee ideas and encourages creative innovations. We're growing, learning, and overflowing with energy. In a dynamic atmosphere that welcomes diversity, we are investing in our employees, along with the growth of our company. We invite you to join us in carrying out our vision to “Be Remarkable!” Apply today!

 

Starting pay is determined based on several factors, which can include the candidate's experience, qualifications, skills, education, and geographic area. 

 

Pay Range:USD $43,000.00 - USD $64,500.00 /Yr.Company Introduction:

Are you friendly, dependable, and passionate about working with people?  At Coborn’s, Inc., we love serving our guests, supporting our communities, and helping our team members grow their careers.  If you’re looking for a place where you can build a future while making a positive impact every day, we’d love to talk to you about joining our team!

 

Coborn's, Inc. is a fast-growing, employee-owned grocery retailer proudly serving communities across the Midwest. Our family of grocery stores includes Coborn's, Cash Wise Foods, Marketplace Foods, Hornbacher's, Tadych’s Marketplace Foods, Sullivan’s Foods, and Kessler’s. We offer our guests an elevated shopping experience—both in-store and online—focused on freshness, value, and convenience. Guided by our company vision to inspire happiness, healthy living, and simplicity, this principle has fueled our growth for more than 100 years and is at the heart of everything we do.

 

Coborn’s, Inc. also owns and operates liquor stores under the Coborn’s Liquor, Cash Wise Liquor, Andy’s Liquor, and Captain Jack’s brands. In addition, we operate fuel kiosks and convenience store locations under the Little Dukes and Coborn’s Express names. Many of our grocery stores also feature full-service pharmacies to support the health and wellness of our guests. We manage a variety of other retail businesses in markets where the fit is right, including Ace Hardware, Country Floral Gifts & Greenhouse, Caribou Coffee, Dunn Brothers Coffee, Erbert and Gerbert’s, Godfather’s Pizza, and Pet Supplies Plus. To support our diverse retail operations, we operate our own central bakery, fresh foods commissary, and grocery warehouse and distribution center.

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