Senior Pharmacy Claims & Reimbursement 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

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