Pharmacy Insurance Specialist — Medicare PDP Advisor

NHS Management, LLC; Northport (AL); Presencial; USD 40.000 - 55.000; Jornada completa

Descripción de la vacante

NHS Management, LLC is seeking a Pharmacy Admin Specialist to bridge pharmacy knowledge with payer negotiations and plan coverage for residents. You will advise on PDP options, enroll for subsidies when applicable, and coordinate with facilities to resolve coverage issues.

The role emphasizes compliance, training of staff, and effective communication with administrators, physicians, and insurance plans to ensure timely billing and paid claims.

Formación

• Knowledge of Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third Party Insurances.
• Strong organization skills and ability to manage multiple tasks in a dynamic environment.
• Strong written and oral communication skills.
• Knowledge of office machines and equipment.
• Basic computer skills; experience with Excel and Word.
• Ability to make independent decisions.

Responsabilidades

• Resolve rejections, denials and PA’s for Medicaid, Medicare D or Private Insurance claims.
• Serve as liaison with Administrators, DONs, Admissions, Social Services and PDP/insurance plans.
• Advise residents and parties on PDP options and subsidy eligibility.
• Provide daily/weekly communications with facilities about coverage issues and resolutions.
• Ensure compliance with internal controls and regulations; participate in plan improvements.
• Provide training to staff to support job performance and cross-functional awareness.

Conocimientos

Organization

Analytical

Communication

Decision making

Teamwork

Pressure handling

Educación

High school diploma

Herramientas

Microsoft Excel

Microsoft Word

Descripción del empleo

NHS Management, LLC is seeking a Pharmacy Admin Specialist to bridge pharmacy knowledge with payer negotiations and plan coverage for residents. You will advise on PDP options, enroll for subsidies when applicable, and coordinate with facilities to resolve coverage issues.

The role emphasizes compliance, training of staff, and effective communication with administrators, physicians, and insurance plans to ensure timely billing and paid claims.