Pharmacy Claims Review Manager

Consonus Pharmacy; Portland (OR); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Paid training

Education benefit: $25,000 toward OJT/

PTO (vacation/sick/holiday)

Health insurance (medical/dental/visi­

MDLIVE telehealth

401K with employer match

Employee Assistance Program

Job summary

Consonus Pharmacy is seeking a Pharmacy Claims Manager to oversee claims processing, adjudication, third‑party billing, and reimbursement optimization for long‑term care environments. The role leads a team to ensure timely submissions, resolve claim exceptions, and maintain compliance with PBMs and government programs.

The ideal candidate has 5+ years in pharmacy claims or PBM operations, with 2+ years in supervision, and a strong understanding of NCPDP standards, Medicare Part D, and Medicaid

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• Minimum 5 years in pharmacy claims, third‑party billing, or PBM operations; LTC experience preferred.
• Minimum 2 years in supervisory or management roles.

Responsibilities

• Oversee all pharmacy claims processing operations including adjudication, third‑party billing, claim rejection management, and reimbursement optimization.
• Lead a team to ensure accurate and timely claim submission and resolution of exceptions.
• Ensure compliance with PBM, Medicare Part D, Medicaid, and commercial payer requirements; adhere to NCPDP standards.
• Collaborate with Billing, Customer Accounts, and Pharmacy Operations to optimize reimbursement and minimize write-offs.

Skills

Analytical reasoning

Supervisory experience

Travel willingness

PBM knowledge

Education

Bachelor's degree in Healthcare Administration / Business / Finance

Tools

Pharmacy management systems

Reporting tools

Job description

Overview

Pharmacy Claims Manager

Consonus Pharmacy is a closed‑door long‑term care pharmacy specializing in the needs of nursing facilities, assisted living residents, and their caregivers. We are currently hiring a Pharmacy Claims Manager to join our team!

As the Pharmacy Claims Manager, your responsibilities include overseeing all pharmacy claims processing operations, including prescription adjudication, third‑party billing, claim rejection management, and reimbursement optimization. This position leads a team responsible for ensuring accurate and timely claim submission, resolution of claim exceptions, compliance with PBM, Medicare Part D, Medicaid, and commercial payer requirements, and adherence to NCPDP standards.

The Pharmacy Claims Manager partners closely with Billing, Customer Accounts, and Pharmacy Operations to ensure accurate reimbursement and compliance, minimize claim write‑offs, and ensure exceptional service to residents, facilities, and payers. In our Long‑Term Care environment, there is a focus on coordination with the Credentialing & Contracting team on payer enrollment issues, and management of LTC‑specific reject queues related to transition fills, hospice billing, and facility census changes.

Benefits

• Paid training & career advancement opportunities
• $25,000 toward ongoing education benefit
• Generous Paid Time Off that pools vacation, sick & holiday pay in a single bucket for flexible use
• Medical/Dental/Vision insurance
• Free access to MDLIVE – allowing access to your health benefits from anywhere
• 401K With Employer Match
• Employee Assistance Program: with free access to counseling & support services

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field; equivalent experience considered.
• Minimum 5 years of pharmacy claims, third‑party billing, pharmacy revenue cycle, or PBM operations experience. Long‑Term Care experience preferred.
• Minimum 2 years of supervisory or management experience.
• Strong understanding of: NCPDP claim standards, Medicare Part D, Medicaid pharmacy billing, Managed Care reimbursement, PBM claim adjudication processes, Pharmacy revenue cycle operations.
• Experience working with PBMs such as Express Scripts, CVS Caremark, OptumRx, Humana, Prime Therapeutics, MedImpact, and Navitus.
• Experience managing Medicare Part D, Medicaid, and dual‑eligible populations.
• Advanced analytical and problem‑solving skills.
• Proficiency with pharmacy management systems and reporting tools.
• Ability to work under pressure in a fast‑paced environment ensuring timely and accurate billing.
• Ability to travel to other pharmacy locations as required.
• Certified Pharmacy Technician (CPhT) preferred (can obtain after hire).

EEO Statement

“Be here. Be you.”
For more than 30 years, Marquis Companies and Consonus Healthcare have been serving seniors and welcoming staff of all backgrounds, skills, and perspectives. The Marquis family of companies offer a rich heritage of embracing differences and honoring individuality. We’ve continued to grow in our appreciation of diversity in the workplace. We know it builds strength, drives innovation, and brings valuable new perspectives and energy.
We’re committed to making our workforce an even greater reflection of the people and communities we serve, and we are honored our employees have chosen to work at Marquis and Consonus. Everything we do as a company is driven by our mission to help those we serve, and each other, live the best rest of our lives.
That means you being you – without apology or compromise. We value your every uniqueness and continue to curate, nurture, and sustain an inclusive culture. It’s the foundation of who we are and the evolution of our collective future.