Pharmacy Billing Manager

OHE OHNH EMP LLC; Kentucky; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Job summary

CommuniCare Family of Companies is hiring a Billing Manager to oversee the day-to-day operation of the billing unit for each pharmacy. You will manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the billing manual.

This role also leads the pharmacy credentialing process for PBM insurers across PSG locations, ensures ongoing credentialing, and ensures compliance with HIPAA, state and federal regulations.

Qualifications

• Experience managing a billing team in a pharmacy setting.
• Familiar with Medicare Part D, Medicaid and commercial payer processes.
• Knowledge of LTC billing workflows and credentialing.
• Ability to ensure compliance with HIPAA and billing policies.

Responsibilities

• Oversee day-to-day billing operations for multiple pharmacies.
• Maintain and update patient accounts across payers.
• Coordinate PBM credentialing and re-credentialing.
• Ensure billing accuracy and adherence to the billing manual.
• Collaborate with facility managers and third-party plans as needed.
• Ensure compliance with HIPAA and state/federal regulations.
• Provide leadership and cross-functional support.

Skills

Team leadership

Long-Term Care pharmacy experience

LTC framework knowledge

Pharmacy payer credentialing

Job description

Job Address

9299 Market Place Broadview Heights, OH 44147

Job Type

Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland

Position Overview

Manage the day to day operation of the billing unit for each pharmacy. Manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the pharmacy billing manual. Help manage the pharmacy credentialing process for various PBM insurance payers (Med D, Managed Medicaid, commercial, ect.) for each PSG pharmacy location.

Key Responsibilities

• Manage the day to day operations of the billing team
• Ensure that all billing processes are followed as outline in the billing manual to ensure consistency and prescription integrity for compliance
• Maintain all current patient accounts by verifying, adding or editing current insurance (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care)
• Works closely with the facility business office managers for Medicare Part D insurance plans and Census clarifications
• Works directly with several hospice plans and third party plans as needed.
• Review the setup of SQL reporting to ensure that all charges are billed appropriate as outlined in the billing manual
• Manage the pharmacy credentialing process for PBM insurance payers (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care) for each PSG pharmacy location
• Ensure all pharmacies are actively credentialed/re-credentialed with PBM insurance payers
• Any other assigned duties assigned
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Qualifications

• 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)
• Experience in Pharmacy insurance payer credentialing (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

Company Overview

Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.