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Job Details

Pharmacy Claims Coordinator

Requisition #: 1896
Location: Johns Hopkins Intrastaff, Hanover, MD 21076
Category: Clerical and Administrative Support
Work Week: Temporary Full Time
Weekend Work Required: No
Date Posted: Dec. 12, 2019

Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Our employees are the strength of our service. Intrastaff is unique because it's one of the very few agencies where a person has the benefit of being a temporary employee and also feels like a member of a large organization. Working at Hopkins means joining a culturally diverse team that includes some of the best nurses, physicians and allied health professionals in the world. Directly or indirectly, you'll have exposure to cutting-edge technology and groundbreaking medical research.

HOURS:

M-F 8:30 - 5:00

LOCATION:

7231 Parkway Drive, Suite 100, Hanover, MD 21076

Requirements:

The Pharmacy Claims Coordinator will 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. This individual will also coordinate resolution of customer service issues regarding pharmacy
services including, but not limited to pharmacy benefits and claims processing. As well as assist clinical staff by
providing information relevant for clinical reviews.

  • Review pharmacy claims to detect gaps in medication fill history
  • Conduct outbound medication adherence member calls to address gaps in care and improve health
    care outcomes under general pharmacist's supervision
  • Communicate with provider offices and in-network pharmacies supporting various clinical programs
    and initiatives
  • Generate and mail template letters to members to support quality improvement programs
  • Initiate member referrals to case management, customer service, other applicable resources
  • Assist with compiling monthly outreach outcome review reports
  • Support Medicare Part D Manager with ad-hoc projects and perform other related duties

Qualifications:

Requirements:

  • High school diploma
  • 2 to 3 years of pharmacy claims adjudication and pharmacy benefit interpretation experience in a managed
    care environment; At least 3 years' experience as a retail Pharmacy Technician and 1 year experience as a
    call center representative or claims examiner may be substituted
  • 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

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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