Pharmacy Claims Coordinator
Requisition #: 231543
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Clerical and Administrative Support
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: May 18, 2020
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.
The Pharmacy Claims Coordinator reports to the Pharmacy Claims Coordinator Supervisor, and assists members, physicians, pharmacist, and internal staff with eligibility issues, non-formulary overrides, claims adjudication and eimbursement issues in accordance with member’s benefit plan. Responsibilities include, but are not limited to;
- Coordinate 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.
- Receive and screen non-formulary/prior-authorization requests from providers. Update requests with required information for review.
- Develop, implement and maintain departmental records and files. Proficiently and accurately document information regarding pharmacy requests.
- Respond to provider and member inquiries regarding pharmacy benefit administration, i.e. member eligibility, formulary management, and delivery of specialty injectable.
- Demonstrate knowledge of pharmacy benefit designs, pharmacy policies and procedures.
- High School Diploma or GED equivalent
- 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
- 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
- Work requires two to three years of pharmacy claims adjudication and pharmacy benefit interpretation experience in a managed care environment. At least three years’ experience
as a retail Pharmacy Technician and 1 year experience as a call center representative or claims examiner may be substituted.
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Johns Hopkins Medicine.