Pharmacy Reimbursement Coordinator II

Since 1983, Johns Hopkins Care at Home has provided safe, high-quality and cost-effective care in the home and community. Our team links care across multiple sites for patients, families and colleagues in an effort to restore, maintain and promote health and reduce the effects of disease and disability. As part of Johns Hopkins Medicine, we have access to the most innovative treatments and latest research, and we emphasize education and training among our team members. We also collaborate with doctors, nurses and specialists throughout Johns Hopkins Medicine to ensure continuity of your care.

What Awaits You?

• Career growth and development
• Diverse and collaborative working environment
• Competitive Benefits Package
• Tuition Assistance

JOB SUMMARY

The Pharmacy Reimbursement Coordinator II performs advanced-level billing and accounts receivable functions for outpatient pharmacy services. This role is responsible for accurate and timely billing to government payors, international and domestic third-party payors, patients, and Johns Hopkins programs to ensure optimal reimbursement. The incumbent demonstrates expertise in reimbursement policies, including government and international payor requirements, and independently researches and resolves complex billing and collection issues. This role serves as a resource to team members, supports training efforts, and maintains strong working relationships with internal stakeholders and external payors.

Minimum Qualifications:

• High School diploma or equivalent required
• Minimum 2+ years of experience in pharmacy and/or medical billing required
• Registration with the State Board of Pharmacy, in the state in which work is performed, required upon hire

Day shift- Monday-Friday; 8am-4:30pm

Remote- Must have the ability to go onsite in Baltimore as needed. Only local applicants will be considered.

Knowledge:

• Knowledge of accounting principles and billing/collections practices
• Understanding of insurance plans, including government and third-party payers
• Familiarity with healthcare billing systems and processes
• Navigate rapidly changing situations, from evolving patient needs to technological advancements, by remaining flexible, continuously learning, embracing new challenges, and quickly recovering from setbacks.
• Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
• Completes basic to moderately complex business support assignments; work involves minimal problem resolution.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy

Essential Functions:

Billing Activities

• Processes and submits claims accurately and timely in accordance with departmental standards and payer requirements.
• Reviews billing reports and resolves errors to prevent delays and ensure compliance with timely filing guidelines.
• Maintains and monitors unbilled accounts and ensures appropriate follow-up.
• Reviews and processes required documentation (e.g., LOAs, EOBs, CMS-1500 forms) for billing accuracy.
• Troubleshoots discrepancies in pricing, authorizations, and documentation; collaborates with internal teams to resolve issues.
• Accounts Receivable (A/R) Follow-Up
• Maintains accuracy and integrity of assigned accounts receivable.
• Conducts timely follow-up, research, and resolution of outstanding balances.
• Identifies and resolves complex issues such as missing payments, underpayments, and payer discrepancies.
• Maintains detailed and accurate documentation of all account activity in billing systems.
• Develops and maintains effective relationships with payors to facilitate timely payment.
• Denials, Credits, and Adjustments
• Reviews and resolves denials, partial payments, and billing discrepancies in a timely manner.
• Initiates appeals, resubmissions, or adjustments in accordance with payer guidelines.
• Processes refunds, credits, and write-offs in compliance with organizational policies.
• Researches and resolves unapplied cash and payment discrepancies.
• Audits & Issue Resolution
• Ensures compliance with payer rules, contracts, and regulatory requirements.
• Identifies trends and root causes of billing issues and recommends corrective actions.
• Collaborates with team members and leadership to resolve complex account issues and improve

Salary Range: Minimum 18.08/hour - Maximum 31.81/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.