MAC Appeals Specialist

WHO WE ARE
At Polaris Pharmacy Services, we’re more than a pharmacy — we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we’re raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.

 Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job — we provide competitive pay, robust benefits, and genuine opportunities for career advancement.

If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.

JOB SUMMARY:

This role owns our Maximum Allowable Cost (MAC) and under reimbursement appeal process: identifying claims reimbursed below acquisition cost, building supporting documentation, and submitting timely appeals to PBMs to recover fair payment. This position requires sharp attention to detail, strong recordkeeping discipline, and confident, professional communication with PBM auditors and provider relations teams.

DUTIES/RESPONSIBILITIES:

MAC Appeals & Reimbursement Recovery

• Monitor claims adjudication data to identify claims reimbursed below the pharmacy's acquisition cost or NADAC due to Maximum Allowable Cost (MAC) pricing.
• Compile MAC appeal packages, including current wholesaler invoices, NDCs, and evidence of drug unavailability at the listed MAC price.
• Submit timely, well-documented MAC appeals to PBMs in accordance with each payer's required format and appeal window.
• Track the status of all submitted appeals, follow up on outstanding requests, and escalate denied or unresolved appeals as needed.
• Analyze appeal outcomes and reimbursement trends to flag drugs/NDCs with chronic underpayment issues for ongoing appeal or formulary discussion.
• Communicate directly with PBM provider relations and pricing teams to resolve disputes and confirm MAC list pricing updates once appeals are substantiated.
• Report reimbursement recovery results, denial trends, and outstanding audit risk to pharmacy leadership on a regular basis.

• Assist PBM and payer audit team in the collection of data such as hard-copy prescriptions, signature logs, proof-of-delivery records, wholesaler invoices, and inventory records — within each PBM's mandated turnaround time.
• Stay current on each PBM's provider manual, network agreement terms, and audit appeal procedures and deadlines.