Senior Pharmacy Claims Lead — Reimbursement & Compliance

Consonus Healthcare; Portland (OR); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Paid training and career advancement

Education stipend $25,000

Generous PTO

Medical/Dental/Vision insurance

MDLIVE access

401K with employer match

Employee Assistance Program

Job summary

Consonus Pharmacy is seeking a Pharmacy Claims Review Manager to oversee all processing operations, including adjudication, third-party billing, and reimbursement optimization. You will lead a team ensuring accurate submissions, resolving claim exceptions, and maintaining payer compliance.

The role focuses on coordinating with Billing, Customer Accounts, and Pharmacy Operations to optimize reimbursement in a long-term care setting, with opportunities for professional growth.

Qualifications

• Bachelor's degree required or equivalent experience.
• 5+ years in pharmacy claims, third-party billing, or PBM operations.
• 2+ years of supervisory or management experience.
• Strong knowledge of NCPDP standards, Part D, Medicaid, and PBMs.

Responsibilities

• Oversee all pharmacy claims processing operations, including adjudication and reimbursement optimization.
• Lead a team to ensure accurate and timely claim submission and minimize write-offs.
• Ensure compliance with PBM, Medicare Part D, Medicaid, and commercial payer requirements.

Skills

Leadership

Analytical thinking

Under pressure

Education

Bachelor's degree in Healthcare Administration, Business, Finance, or related field

Equivalent experience considered

Tools

Pharmacy management systems

Reporting tools

Job description

Consonus Pharmacy is seeking a Pharmacy Claims Review Manager to oversee all processing operations, including adjudication, third-party billing, and reimbursement optimization. You will lead a team ensuring accurate submissions, resolving claim exceptions, and maintaining payer compliance.

The role focuses on coordinating with Billing, Customer Accounts, and Pharmacy Operations to optimize reimbursement in a long-term care setting, with opportunities for professional growth.