What are the responsibilities and job description for the Pharmacy Claims Supervisor position at CommuniCare Health Services?
Position Overview: The Claims Specialist 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 Includes But Is Not Limited To
Key Responsibilities Includes But Is Not Limited To
- 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
- 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)
- Competitive salary commensurate with experience
- Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more
