Pharmacy Claims Audit Supervisor

🕒 August 24

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $47.3k - $67.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 27%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Supervise claims program administration to ensure proper claims practices and procedures • Supervise billing, claims and associated administrative activities for compliance with laws, regulations, policies, agreements and contractual arrangements • Assist in implementing procedures to adjust claims with erroneous demographic, sponsor or charge information • Monitor and control resubmission of denials, rejections and appeals • Intercede with third parties in unusual situations involving payment or adjustment of charges • Consult with departments concerning services affecting collection of charges • Assist examiners in investigating claims and assist or perform settlement negotiations • Supervise claim settlement processing • Supervise electronic and paper claims submissions • Oversee analysis, correction and resubmission of registration and eligibility edits and errors • Recommend and/or initiate employee selection and hiring • Train and evaluate employees • Address performance issues and recommend personnel actions • Recommend salary increases, transfers and terminations to manager • Research coding and reimbursement requirements for compliance with local, state and federal regulations

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience • Bachelor's degree in business administration, insurance or related field preferred • Six or more years of claims experience • Two or more years of leadership experience • Experience working with proper claims handling, policies and procedures • Experience working with computer based analysis tools • Experience working with insurance and/or medical terminology • Organizational skills to balance and prioritize work • Analytical and problem solving skills • Communication skills • Human relations skills to select, develop, mentor, discipline and reward employees • Negotiation skills to interact with claimant • Ability to understand and convey applicable laws, regulations and practices regarding the insurance industry • Ability to work independently and lead group activities

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning • Career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies