Latest / The Side Hustle Career Podcast with Fexingo: Second Income, Freelancing While Employed / How a Pharmacy Tech Built a 5K Monthly Side Hustle in Drug Reimbursement Audits
Transcript
- Lucas: So there's this moment in every pharmacy visit — you hand over your insurance card, the tech types, the pharmacist checks, and you get a price. Most people assume that price is just what it is. But behind that number is a thicket of codes, contracts, and sometimes, just plain errors. Luna: And those errors can cost a pharmacy thousands a month. That's where today's guest — let's call her Sarah — built her side hustle. Lucas: Sarah is a certified pharmacy technician who worked at a chain for years. She knew the billing system cold. One day she noticed a recurring claim denial on a common blood pressure medication — a Medicare Part D plan kept rejecting it because of a mismatch between the National Drug Code and the plan's preferred brand. Lucas: She fixed it, and the pharmacist said, 'You just saved us $400 on that one claim. Can you look at the rest?' So she did. Over a weekend, she audited a month of rejected claims and found about $3,200 in recoverable revenue. Luna: That's a big number for a single independent pharmacy. And she wasn't even looking that hard. Lucas: Exactly. She realized this was a skill she could sell. She approached a few local independents — the kind that don't have a full-time billing specialist — and offered a flat-fee audit. Her rate: $500 per audit, plus 20 percent of any recovered revenue she found. Luna: And before we go deeper, if you're finding value in these concrete side-hustle breakdowns, you can support the show by buying us a coffee at buy me a coffee dot com slash fexingo. It helps keep us ad-free and focused on the real numbers. Lucas: Yeah, honestly, if today's episode saves you even a few hours of research, that's worth a cup. No pressure at all. Luna: So back to Sarah — how many clients did she land initially? Lucas: Three in the first month. She spent about 15 hours per audit — learning the quirks of each pharmacy's software and the specific plan contracts they had. By month three, she had six clients and was averaging $4,200 a month. Luna: And what exactly is she looking for in those audits? I imagine it's more than just a wrong code. Lucas: It's a mix. The biggest bucket is something called 'coverage gap' errors — Medicare Part D's donut hole. Patients hit it, and the pharmacy should bill a different amount, but the system often defaults to the wrong rate. Another common one is 'dispensing fee' underpayment — plans sometimes pay less than the contracted fee, and it adds up. Lucas: She also finds 'therapeutic interchange' issues — when a doctor prescribes a brand, but the plan covers a generic at a different rate. If the pharmacy doesn't check, they lose money on the claim. Luna: So it's not just about knowing the codes — it's about understanding the contracts. That seems like a barrier for someone without her background. Lucas: It is, but it's learnable. Sarah says the key resource is the Medicare Part D manual — it's publicly available, about 300 pages. She read the first 50 pages on coverage gap rules and that alone gave her enough to find errors. Lucas: And the second piece is the pharmacy's own contracts with insurers. Those are usually in a file somewhere. She asks for them, reads the reimbursement rates, and compares them to what the system actually paid. Luna: Okay, so the upfront work is reading contracts and a government manual. That's maybe a weekend of focused effort. Lucas: Right. And then she built a simple Excel template — a spreadsheet with columns for claim ID, drug, NDC, amount billed, amount paid, expected reimbursement, and a flag if the difference is more than five bucks. She runs the pharmacy's claims report through it manually. Luna: So it's not automated. That keeps it accessible — no coding required. Lucas: Exactly. She's not a programmer. She just knows Excel formulas — VLOOKUP, IF statements — and she uses those to flag discrepancies. For a typical independent pharmacy doing about 200 claims a day, she can audit a month in about 10 hours once she's familiar with their setup. Luna: And the fee structure — flat fee plus a cut — that's pretty standard in consulting. But does she have to chase the pharmacy to actually pay her the percentage? Lucas: She learned that lesson fast. First client, she found $2,800 in recoverable claims, but the pharmacy took four months to submit the corrected claims and then another two months to get paid. She had to wait for the reimbursement to hit before she got her cut. Lucas: So she switched to a model where she takes a higher flat fee — $700 — and a smaller percentage, 10 percent. That way she gets paid upfront for her time, and the success fee is bonus. Luna: That's smart. It also signals confidence — 'I'm so sure I'll find errors that I'll take less on the back end.' Lucas: Right. And it works because the typical independent pharmacy has slim margins — maybe 2 to 3 percent. So saving $1,000 a month is a big deal to them. Her clients tend to stick around because she's saving them real money. Luna: I want to talk about the cold-emailing piece. How did she approach those first few pharmacies without a reputation? Lucas: She literally printed a one-page flyer that said, 'I can find errors in your Part D claims. Free trial for one week.' She took it to five independents near her. Two said no, three said yes. For the free trial, she spent four hours at each, found an average of $600 in errors per pharmacy, and then pitched the paid audit. Luna: So the free trial converted. That's a classic service-business move. Lucas: It is. And now she's at a point where she has a waitlist. She's even training a second technician she hired part-time, because she can't keep up with demand. She's been doing this for about 18 months and it's grown to $5,000 to $6,000 a month. Lucas: And the interesting thing — she still works her day job as a pharmacy tech two days a week because she likes the structure and benefits. Luna: That's a nice balance. So who is this for? Someone who already works in a pharmacy? Or could a complete outsider learn this? Lucas: Sarah says the fastest path is if you're already a pharmacy tech or a billing specialist. You're halfway there. But if you're not, she recommends taking a free online course on medical billing — there's one from the American Association of Medical Billers — and then spending a few hours shadowing a pharmacy tech friend. Lucas: The key skill is attention to detail. You're comparing numbers line by line. It's not glamorous, but it pays. Luna: I can see this being especially resilient to automation, too — because it's about understanding contracts, which change every year. Lucas: Exactly. Medicare Part D plans change formulary and reimbursement rates annually. Each pharmacy has different contracts. So there's always a new set of data to check. It's not a 'set it and forget it' problem. Luna: So if someone wants to start tomorrow, what's the first concrete step? Not the course — something they can do tonight. Lucas: Sarah says: download the Medicare Part D coverage gap fact sheet from CMS.gov. It's a two-page PDF. Read it. Then look up the NDC for a common drug like atorvastatin — that's generic Lipitor — and see how the pricing works. If that sparks curiosity, you're on the right track. Luna: That's a great low-barrier entry. And from there, you could reach out to an independent pharmacy you know and offer exactly what Sarah did — a free trial. Lucas: Right. And if you don't know a pharmacist, you can look up independent pharmacies on Google Maps. There are about 22,000 independents in the U.S. Most are small family operations. They're a perfect market for this kind of niche service. Luna: Nice. So we'll put the CMS link in the show notes. Lucas, final thought? Lucas: Just that this is a great example of taking a skill you already have — or can learn in a few weeks — and packaging it as a service for a specific, underserved customer. Sarah didn't invent anything. She just looked at a problem that everyone assumed was too small to fix. Luna: And that's the real side-hustle insight: find the tedious, repetitive thing that businesses ignore, and offer to do it for them. Lucas: Exactly. Thanks for listening, everyone. We'll be back next week with another build.