We are seeking a Pharmacy Billing Specialist to join our Revenue Cycle Management (RCM) team.

In this role, you will manage end-to-end pharmacy claims, with a primary focus on Medication Therapy Management (MTM) and vaccine billing, alongside standard PBM adjudication and dual-benefit claims processing.

? Key Responsibilities

? MTM & Clinical Billing

Process and submit claims for Medication Therapy Management services (CPT 99605–99607), ensuring accurate documentation and coding for comprehensive medication reviews (CMR/TMR).

? Immunization & Vaccine Claims

Execute billing for vaccines and administration fees under both pharmacy and medical benefits (CPT/HCPCS and Medicare G-codes).

? Claims Adjudication & Rejections

Transmit real-time NCPDP D.0 claims and resolve rejections, including prior authorizations, plan limits, and DAW codes.

? Dual-Benefit & Appeals





Navigate complex claims requiring CMS-1500 / EDI 837P submission, manage aging A/R, and file appeals to prevent payer clawbacks.

? Qualifications & Requirements

✅ Experience: 2–4+ years in pharmacy billing, with hands-on experience in MTM and vaccine coding.

✅ Certification: Certified Pharmacy Technician (CPhT) preferred; CPCB or CMRS certifications are a plus.

✅ Technical Skills: Solid proficiency in MTM CPT codes, vaccine administration coding, NDC routing, BIN/PCN, ICD-10, and HCPCS modifiers.

✅ Software: Familiarity with pharmacy management software such as PioneerRx, QS/1, EnterpriseRx and portals like CoverMyMeds.

📌 Pharmacy Billing Specialist (India)
🏢 El Mejor Medical Billing
📍 India