Pharmacy Claims Supervisor

CommuniCare Health Services; Cabin Creek (WV); On-site; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a Claims Specialist Supervisor to oversee the daily operations of the post adjudication team. This role involves managing the insurance claims process, ensuring accurate and timely processing of claims, and providing exceptional customer service to clients. The successful candidate will analyze and approve claims, determine coverage, and apply medical necessity guidelines while adhering to federal and state regulations. With a comprehensive benefits package and a competitive salary, this position offers a rewarding opportunity for those looking to make a significant impact in healthcare operations.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k) with Company Match

Paid Time Off

Qualifications

• Pharmacy Tech License is required.
• Management experience is a plus but not mandatory.

Responsibilities

• Manage daily operations of the post adjudication team.
• Ensure accurate processing of claims and resolve discrepancies.

Skills

Claims Management

Customer Service

Problem Solving

Knowledge of HIPAA Guidelines

Education

Pharmacy Tech License

Management Experience

Long-Term Care Pharmacy Experience

Job description

Position Overview: The Claims Specialist Supervisor will manage the day to day operation of the post adjudication team. You will manage the insurance claims process while providing customer service to clients. Analyze and approve claims that cannot be adjudicated. Determine coverage and apply medical necessity guidelines. Identify and clarify any discrepancies to assist in the adjudication process.

Key Responsibilities Includes but is not limited to:

1. Manage the day to day operations of the post adjudication team
2. 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 that need attention
7. Resolve any discrepancies and secure proper reimbursement
8. The Supervisor will ensure that all items outlined in the Billing Manual - sub section Claims Specialist will be followed.
9. 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:

1. Pharmacy Tech License
2. Management of a team of employees a plus (but not required)
3. Previous Long-Term Care pharmacy experience a plus (but not required)
4. Knowledge of Framework LTC a plus (but not required)

Salary and Benefits:

1. Competitive salary commensurate with experience
2. Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more