Pharmacy Claims Supervisor
1 week ago
Position Overview
The Pharmacy Claims Supervisor will manage the day to day operation of post adjudication team. You will manage the insurance claims process, while providing customer service to clients. Analyze and approve claims that cannot be adjudicated. Determines coverage and applies medical necessity guidelines. Identifies and clarifies any discrepancies to assist in the adjudication process.
Key Responsibilities
Manage the day to day operations of the post adjudication team
Claim submissions and corrections
Ensure accurate and timely processing of rejected claims
Work directly with third party payers for claim resolution
Collaborate with leadership teams to resolve denied claims
Communicate with facilities claim issues that will need attention by the facility
Resolve any discrepancies and secure proper reimbursement
The Supervisor will ensue that all items outline in the Billing Manual- sub section Claims Specialist will be followed.
Any other duties assigned
Follow federal and state regulations
Adhere to company policies and procedures
Follow HIPPA guidelines and regulations
Qualifications and Requirements
Pharmacy Tech License
Management of a Team of employees a plus (but not required)
Previous Long-Term Care pharmacy experience a plus (but not required)
Knowledge of Framework LTC a plus (but not required)
Salary and Benefits
Competitive salary commensurate with experience
Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more
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