Pharmacy Adjudication Manager

Job not on LinkedIn

August 22

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

🦀 Maryland – Remote

Although this job is listed in Maryland, this company may be open to hiring remote in other states.

+2 more states

🏈 Ohio – Remote 🦀 Maryland – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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CommuniCare Health Services

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Healthcare Insurance • Social Impact • Therapy

CommuniCare Health Services is a behavioral health agency located in Gilbert, Arizona, dedicated to strengthening families through various supportive services. They focus on providing a safe and empowering environment for youth and families, offering programs such as case management, therapy, residential treatment, and life skills coaching. With over 20 years of experience, their mission is to promote healing and resilience in the communities they serve, respecting individual cultural beliefs while fostering personal growth and positive outcomes.

5001 - 10000 employees

Founded 1984

⚕️ Healthcare Insurance

🌍 Social Impact

📋 Description

• Manage the day to day operation of the Claims Adjudication Center (real time-Adjudication) • 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 • 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

🎯 Requirements

• 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)

🏖️ 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