Pharmacy Credentialing / Billing Manager

Pharmacy Credentialing / Billing Manager

Job Address : 9299 Market Place Broadview Heights, OH 44147

Pharmacy Credentialing / Billing Manager

Job Type : Full-Time Remote Pharmacies : West Virginia, Ohio, Indiana and Maryland

Position Overview : Manage the pharmacy credentialing process for various PBM insurance payers (Med D, Managed Medicaid, commercial, etc.) for each PSG pharmacy location. Manage the day to day operation of the billing unit for each pharmacy. Manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the pharmacy billing manual.

Key Responsibilities :

• Manage the pharmacy credentialing process for PBM insurance payers (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care) for each PSG pharmacy location
• Ensure all pharmacies are actively credentialed / re-credentialed with PBM insurance payers
• Manage the day to day operations of the billing team
• Ensure that all billing processes are followed as outlined in the billing manual to ensure consistency and prescription integrity for compliance
• Maintain all current patient accounts by verifying, adding or editing current insurance (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care)
• Works closely with the facility business office managers for Medicare Part D insurance plans and Census clarifications
• Works directly with several hospice plans and third party plans as needed
• Review the setup of SQL reporting to ensure that all charges are billed appropriate as outlined in the billing manual
• Any other assigned duties
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Qualifications :

Salary and Benefits :