Pharmacy Claims Coordinator
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States.
JHHC is a $2.
5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments.
JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it.
We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve.
If you are interested in improving how healthcare is delivered, join the JHHC team.
POSITION
Summary:
Reports to the Pharmacy Claims Coordinator Supervisor, assist members, physicians, pharmacist, and internal staff with eligibility issues, non-formulary overrides, claims adjudication and reimbursement issues in accordance with member's benefit plan.
Coordinates resolution of customer service issues regarding pharmacy services including, but not limited to; pharmacy benefits and claims processing.
Assist clinical staff by providing information relevant for clinical reviews.
TASK REQUIREMENTS FOR POSITION:
Receives and screens non-formulary/prior-authorization requests from providers.
Updates requests with required information for review.
Develop, implement and maintain departmental records and files.
Proficiently and accurately documents information regarding pharmacy requests.
Responds to provider and member inquiries regarding pharmacy benefit administration, ie member eligibility, formulary management, and delivery of specialty injectable.
Demonstrate knowledge of pharmacy benefit designs, pharmacy policies and procedures.
REQUIREMENTS:
A.
Education:
High school diploma B.
Knowledge:
Knowledge of prescription drug products and Over The Counter (OTC) drugs, familiarity and ability to use pharmacy reference books.
Knowledge of medical terminology claims codes.
Knowledge of Managed Care pharmacy claims processing C.
Skills:
Excellent interpersonal skills necessary to handle sensitive and confidential information, and to interact with a diverse patient population, providers and staff.
Strong PC and software application skills.
Experience with data entry.
Excellent administrative/organizational skills.
Advanced analytical ability is required in order to gather and interpret data , and resolve moderately complex problems D.
Required Licensure, Certification, Etc.
:
None E.
Work
Experience:
Work requires two to three years of pharmacy claims adjudication and pharmacy benefit interpretation experience in a managed care environment.
At least three years' experienc as a retail Pharmacy Technician and 1 year experience as a call center representative or claims examiner may be substituted.
F.
Machines, Tools, Equipment:
Must be able to operate general office and communications equipment including a computer.
Estimated Salary: $20 to $28 per hour based on qualifications.
JHHC is a $2.
5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments.
JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it.
We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve.
If you are interested in improving how healthcare is delivered, join the JHHC team.
POSITION
Summary:
Reports to the Pharmacy Claims Coordinator Supervisor, assist members, physicians, pharmacist, and internal staff with eligibility issues, non-formulary overrides, claims adjudication and reimbursement issues in accordance with member's benefit plan.
Coordinates resolution of customer service issues regarding pharmacy services including, but not limited to; pharmacy benefits and claims processing.
Assist clinical staff by providing information relevant for clinical reviews.
TASK REQUIREMENTS FOR POSITION:
Receives and screens non-formulary/prior-authorization requests from providers.
Updates requests with required information for review.
Develop, implement and maintain departmental records and files.
Proficiently and accurately documents information regarding pharmacy requests.
Responds to provider and member inquiries regarding pharmacy benefit administration, ie member eligibility, formulary management, and delivery of specialty injectable.
Demonstrate knowledge of pharmacy benefit designs, pharmacy policies and procedures.
REQUIREMENTS:
A.
Education:
High school diploma B.
Knowledge:
Knowledge of prescription drug products and Over The Counter (OTC) drugs, familiarity and ability to use pharmacy reference books.
Knowledge of medical terminology claims codes.
Knowledge of Managed Care pharmacy claims processing C.
Skills:
Excellent interpersonal skills necessary to handle sensitive and confidential information, and to interact with a diverse patient population, providers and staff.
Strong PC and software application skills.
Experience with data entry.
Excellent administrative/organizational skills.
Advanced analytical ability is required in order to gather and interpret data , and resolve moderately complex problems D.
Required Licensure, Certification, Etc.
:
None E.
Work
Experience:
Work requires two to three years of pharmacy claims adjudication and pharmacy benefit interpretation experience in a managed care environment.
At least three years' experienc as a retail Pharmacy Technician and 1 year experience as a call center representative or claims examiner may be substituted.
F.
Machines, Tools, Equipment:
Must be able to operate general office and communications equipment including a computer.
Estimated Salary: $20 to $28 per hour based on qualifications.
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