- Commonwealth Care Alliance (Boston, MA)
- …and long term services and supports. Works closely with delegated entities, pharmacy , dental and other vendors to assure integration, oversight, and efficiency of ... management functions with network strategy, vendor relationship management and claims processing. Works closely with provider relations on resolving provider… more
- Marshfield Clinic (Marshfield, WI)
- …law and third-party reimbursement rules. **Preferred/Optional:** Three years' experience in pharmacy claims processing. Experience in technical writing and ... to support the most exciting missions in the world!** **Job Title:** Pharmacy Systems Support Specialist Senior **Cost Center:** 301641560 System Ancillary… more
- Centene Corporation (Austin, TX)
- …a Monday - Friday; 2:00 pm - 10:30 pm EST, schedule.** **Position Purpose:** The Senior Pharmacy Resolution Specialist will act as a subject matter expert and ... everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is...handles more complex pharmacy issues and respond to escalated calls from members,… more
- Elevance Health (Indianapolis, IN)
- **Account Service Manager Sr - Pharmacy Benefit Management** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration ... for employment, unless an accommodation is granted as required by law._ **CarelonRx Pharmacy ** is now part of CarelonRx (formerly IngenioRx), a proud member of the… more
- CenterWell (Phoenix, AZ)
- …of our caring community and help us put health first** The Specialty Operations Pharmacy Technician 2 adjudicates pharmacy claims and process pharmacy ... for the following: + Analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment,...at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more
- Fair Haven Community Health Care (New Haven, CT)
- …with regards to the 340B program. + Provide leadership and guidance to pharmacy staff, fostering professional development and training for 340B program. + ... and dental care, regardless of ability to pay. Job purpose The Pharmacy Operations & 340B Program Manager provides strategic direction, operational oversight, and… more
- AdventHealth (Apopka, FL)
- … Processing Manager is responsible for all activities regarding Rx Plus Pharmacy 's state licensed data entry, claims adjudication, prior authorization, ... prescription order intake of various media, technician quality assurance, claims adjudication and copay assistance, prior authorization, and prescription… more
- Trinity Health (Westerville, OH)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** Certified Pharmacy Technician Senior will assist the pharmacist in delivering timely, ... exceptional customer service by addressing patient questions and concerns. The Certified Pharmacy Technician Senior is expected to participate in quality… more
- BrightSpring Health Services (Union City, CA)
- … solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled ... individual to join our team. PharMerica is a non-retail pharmacy that focuses on providing exceptional customer service and...Identifies and resolves issues of denials or follow-up of claims , by maintaining current knowledge of Medicaid claim… more
- State of Massachusetts (Boston, MA)
- …vehicles deemed appropriate to inform the Division's various audiences. The Director of Pharmacy Benefit Manager Oversight is a senior management level position ... be required to evaluate carriers' compliance with coding and claims practices. * Oversee the licensure of Pharmacy...to MGL c. 176Y. * Coordinate and communicate with senior management staff to ensure that staff are aware… more
- Henry Ford Health System (Troy, MI)
- …other regulatory updates. + Develop and maintain actuarial models to analyze pharmacy claims experience, utilization patterns, pipeline drugs, biosimilars, GLP-1 ... Strategic Importance Pharmacy is one of the fastest-growing and most...for resolution. + Prepare executive-level presentations and recommendations for senior leadership and governance bodies. + Reduce reliance on… more
- UHS (Johnson City, NY)
- …Provide immunizations and other health screenings in compliance with state laws and pharmacy protocols + Manage and verify insurance claims and prior ... OverviewUnited Health Services (UHS) is seeking a dedicated Pharmacist to join our pharmacy team. The Pharmacist will ensure the safe and accurate administration of… more
- Comcast (Philadelphia, PA)
- …we want you to fast-forward your career at Comcast. **Job Summary** The Senior Director of Global Benefits is responsible for designing and implementing health care ... health care financial forecasting/underwriting principles including self-insured medical and pharmacy plan administration and payment models. + Provides oversight… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp Health ... of our members related to their medical, behavioral health and pharmacy needs. This position also provides the physician cohesive collaboration necessary… more
- CVS Health (Denver, CO)
- …Trifacta, Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health ... to join our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team....You will work with a collaborative, close-knit team on pharmacy and member specific claims data including,… more
- BrightSpring Health Services (Nashville, TN)
- …Sr Director's responsibilities include identifying reimbursement issues, ensuring that claims , denials, and appeals are efficiently processed, and resolving ... of month closing procedures. + Develop sustainable processes to bill and adjudicate claims timely to maintain a benchmark cash goal. + Develop denial management… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Healthcare Analyst Senior Location: Hybrid | Eagan, Minnesota Career Area: Data Analytics & Business ... ready to make a difference, join us. The Impact You Will Have The Senior Healthcare Analyst is responsible for contributing to and supporting the strategic needs of… more
- CareFirst (Baltimore, MD)
- …markets risk score methodologies, risk score calculations, enrollment, submissions, medical and pharmacy claims , and provider data. Incumbent is responsible for ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a...support as required. We are looking for an experienced professional in the greater Baltimore metropolitan area who is… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …driving successful IT development initiatives within the Pharmacy Benefits Manager (PBM) claims space. As a Senior Consultant, you will serve as a critical ... protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Business Systems Consultant Location: Hybrid | Eagan, Minnesota Career Area:… more
- Royal Electric (Monterey, CA)
- …documentation including but not limited to submittals, RFI's, delay notices, potential claims , and extended overheads. + Maximize cash flow by balancing project cost ... Dependent care (Daycare children & elderly - work related), & Transit + Pharmacy discounts + Kisx Card (Surgery & Imaging Program) + Opportunity for tuition… more
