Pharmacy Adjudication Manager

Job Summary

A company is looking for a Pharmacy Adjudication Manager to oversee the Claims Adjudication Center operations.

Key Responsibilities

• Manage daily operations of the Claims Adjudication Center, ensuring timely processing of real-time claims
• Collaborate with the Claims Intervention Center, Prior Authorization, and Billing Departments
• Provide education and training to staff while ensuring compliance with federal and state regulations

Qualifications

• Pharmacy Technician License in Ohio, West Virginia, Indiana, and Maryland (preferred)
• Previous Long-Term Care pharmacy experience is a plus (but not required)
• Knowledge of Framework LTC is a plus (but not required)
• Experience in Pharmacy Claim Adjudication, preferably in Long-Term Care pharmacy