Pharmacy Claims Processing Specialist
Careers with real impact.
Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.
ABOUT ORSINI
Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.
OUR MISSION
Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.
CORE VALUES
At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.
COMPENSATION & LOCATION
The salary range for this role is $25
This position is remote but may require some travel to attend meetings and events.
POSITION SUMMARY
The Pharmacy Claims Specialist is responsible for adjudicating pharmacy claims, monitoring workflow queues, reviewing billing accuracy, and resolving rejected claims to ensure timely and accurate processing. This role requires strong attention to detail, analytical skills, and knowledge of pharmacy claims processing systems to support efficient reimbursement and compliance with payer requirements.
ESSENTIAL DUTIES
- Claims Adjudication and Processing: Verifying and processing pharmacy claims to ensure they are accurate, complete, and compliant with insurance policies.
- Resolving Claim Rejections: Investigating and resolving discrepancies in claims, such as prescription errors, eligibility issues and entering claim overrides.
- Collaboration: Coordinating with insurance companies to resolve claim issues and ensure timely processing
- Billing Review and Compliance: Review pharmacy billing data for accuracy and resolve discrepancies before claim submission.
- Coordinate with other departments (e.g., therapy teams, contracting, finance) to ensure alignment of processes and efficiency in claim resolution.
- Ensure compliance with federal, state, and local regulations, as well as company policies, including healthcare regulations (e.g., HIPAA, Medicaid, Medicare, ACA).
- Other duties and responsibilities as required.
Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description.
KNOWLEDGE, SKILLS, AND TRAINING
- At least 1 year experience within Specialty Pharmacy operations setting
- Proficiency with pharmacy claims processing systems, CareTend preferred
- Attention to Detail: High level of accuracy in reviewing claims to avoid errors
- Communication Skills: Ability to communicate effectively with healthcare providers, insurance representatives, to resolve claims-related issues.
- Strong analytical and problem-solving skills
- Strong understanding of healthcare regulations, including HIPAA, Medicare, and ACA requirements
- Detailed-oriented with strong organizational skills
- Pharmacy Technician License preferred
EMPLOYEE BENEFITS
We offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:
- Medical Coverage, Dental, and Vision Coverage
- 401(k) with employer match
- Accident and Critical Illness coverage
- Company-paid life insurance options
- Generous PTO, paid holidays, and floating holidays
- Tuition reimbursement program.
Equal Employment Opportunity
Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.
Americans with Disabilities Act
Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.
E-Verify Participation Notice
We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.
All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.
For more information about E-Verify, please review the official notices below:
E-Verify Participation Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf
Right to Work Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf