Pharmacy Adjudication Manager

CommuniCare Health Services

176d • Remote

About The Position

Manage the day to day operation of the Claims Adjudication Center for each pharmacy. Manage real time insurance claims,while providing customer service to clients. Analyze and approve live claims in timely manner as to not slow down the filling process within the pharmacy. Determines coverage and applies medical necessity guidelines. Identifies and clarifies any discrepancies to completed the adjudication process.

Requirements

• Pharmacy Technician License in Ohio, West Virgina, Indiana and Maryland (preferred)
• Experience in Pharmacy Claim Adjudication (LTC pharmacy experience preferred)

Nice To Haves

• Previous Long-Term Care pharmacy experience a plus (but not required)
• Knowledge of Framework LTC a plus (but not required)

Responsibilities

• Manage the day to day operations of the Claims Adjudication Center (real time-Adjudication)
• Work in cohesion with the Claims Intervention Center, Prior Authorization, and Billing Departments
• Adress Batch/Claim submissions and corrections
• Ensure accurate and timely processing of real time claims
• Work directly with third party payers for claim resolution
• Communicate with facilities claim issues that will need attention by the facility
• Provide education and training to staff
• Proficient in record keeping (employee tracking and workflow)
• Any other duties assigned
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Benefits

• Competitive salary commensurate with experience
• Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed