Pharmacy Claims Coordinator I

1 week ago

Hanover, United States Johns Hopkins HealthCare Full time

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

  • Work-life balance - This is a hybrid role. Must work every other Weds onsite in Hanover, MD office from 8:30-5.
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE
Who you are:

You are a Pharmacy Tech who has worked in a managed care Pharmacy environment. You understand Pharmacy Benefits Manager (PBM) claims' processing and prior authorization. Your superior communication and interpersonal skills allow you to easily interact with a diverse patient population, providers and staff. You know that your job impacts our customer's experience; our members, physicians, pharmacists, and internal customers will all benefit from your attention to details that matter.

What you'll do:
  • Perform review of daily rejected claims and initiate resolution as needed
  • Conduct and receive calls to/from members, providers and pharmacies regarding gaps in medication adherence, therapeutic interchange, and other pharmacy clinical programs
  • Assist in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
  • Assist in monitoring program initiatives, outcomes, and objectives to ensure goal attainment
  • Coordinate member and provider correspondence regarding pharmacy clinical programs
  • Supports the pharmacist with completion of comprehensive medication reviews and other clinical initiatives through pre-work up and case preparation.
What you'll bring:
  • 2+ years' experience in pharmacy claims adjudication and pharmacy benefit interpretation in a managed care environment.
    • 3+ years' experience as a retail Pharmacy Technician and 1 year experience as a call center representative or claims examiner may be substituted.
    • High school diploma or GED required


    Who we are:

    Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

    Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

    Salary Range: Minimum 19.00 per hour - Maximum 30.24 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

    In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

    JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins

    Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

    Johns Hopkins Health System and its affiliates are drug-free workplace employers.

    Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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