Pharmacy Claims Supervisor

CommuniCare; Cabin Creek (WV); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company is seeking a Claims Specialist Supervisor to oversee the post-adjudication team. You will manage the claims process, ensuring accuracy and compliance with regulations, while providing guidance and support to your team. This role offers competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits package

401(k) with company match

Paid time off

Health, dental, and vision insurance

Qualifications

• Previous Long-Term Care pharmacy experience is a plus.
• Management experience with a team is a plus.
• Knowledge of Framework LTC is beneficial.

Responsibilities

• Manage daily operations of the post-adjudication team.
• Ensure accurate processing of rejected claims.
• Collaborate with teams to resolve denied claims.

Skills

Management experience

Knowledge of Framework LTC

Education

Pharmacy Tech License

Job description

Position Overview: The Claims Specialist Supervisor will manage the day-to-day operations of the post-adjudication team. You will oversee the insurance claims process while providing customer service to clients. Responsibilities include analyzing and approving claims that cannot be automatically adjudicated, determining coverage, and applying medical necessity guidelines. The supervisor will also identify and clarify discrepancies to assist in the adjudication process.

Key Responsibilities include but are not limited to:

1. Manage the daily operations of the post-adjudication team.
2. Handle claim submissions and corrections.
3. Ensure accurate and timely processing of rejected claims.
4. Work directly with third-party payers for claim resolution.
5. Collaborate with leadership teams to resolve denied claims.
6. Communicate with facilities regarding claim issues requiring attention.
7. Resolve discrepancies and secure proper reimbursement.
8. Ensure all procedures outlined in the Billing Manual, subsection Claims Specialist, are followed.
9. Perform any other duties assigned.
10. Follow federal and state regulations.
11. Adhere to company policies and procedures.
12. Follow HIPAA guidelines and regulations.

Qualifications and Requirements:

• Pharmacy Tech License.
• Management experience with a team of employees is a plus (but not required).
• Previous Long-Term Care pharmacy experience is a plus (but not required).
• Knowledge of Framework LTC is a plus (but not required).

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.