CommuniCare Health
Pharmacy Adjudication Manager
CommuniCare Health, Broadview Heights, Ohio, United States, 44147
Pharmacy Adjudication Manager page is loaded Pharmacy Adjudication Manager Apply locations Pharmacy Solutions Group - Ohio Pharmacy Solutions Group - Maryland Pharmacy Solutions Group - Indiana Pharmacy Solutions Group - West Virginia time type Full time posted on Posted 5 Days Ago job requisition id R-0000104654
Job Address: 9299 Market PlaceBroadview Heights, OH 44147
Job Title:
Pharmacy Claims Adjudication Manager Reports to : Director of Claims Intervention Center Job Type : Full-Time – Remote – Pharmacies located in: West Virginia, Ohio, Indiana and Maryland Position Overview : 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. Key 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 Qualifications : Pharmacy Technician License in Ohio, West Virgina, Indiana and Maryland (preferred) Previous Long-Term Care pharmacy experience a plus (but not required) Knowledge of Framework LTC a plus (but not required) Experience in Pharmacy Claim Adjudication (LTC pharmacy experience preferred) 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
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Job Address: 9299 Market PlaceBroadview Heights, OH 44147
Job Title:
Pharmacy Claims Adjudication Manager Reports to : Director of Claims Intervention Center Job Type : Full-Time – Remote – Pharmacies located in: West Virginia, Ohio, Indiana and Maryland Position Overview : 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. Key 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 Qualifications : Pharmacy Technician License in Ohio, West Virgina, Indiana and Maryland (preferred) Previous Long-Term Care pharmacy experience a plus (but not required) Knowledge of Framework LTC a plus (but not required) Experience in Pharmacy Claim Adjudication (LTC pharmacy experience preferred) 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
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