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Job Description
Pharmacy Claim Adjudication Supervisor
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.
Key responsibilities include:
- Work in cohesion with the Claims Intervention Center, Prior Authorization and Billing Departments
- Review claim submissions and adjust for 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
- Resolve any discrepancies and secure proper reimbursement
- Provide education and training to staff
- Any other duties assigned
- Follow federal and state regulations
- Adhere to company policies and procedures
- Follow HIPPA guidelines and regulations
Qualifications and requirements:
- Pharmacy Technician License in Ohio, West Virgina, Indiana and Maryland (All is preferred, but not required)
- Management of a Team of employees a plus (but not required)
- Previous Long-Term Care pharmacy experience a plus (but not required)
- Knowledge of Framework LTC a plus (but not required)
Salary and 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