Job Information
Johns Hopkins Medicine Supervisor, Pharmacy Claims in Glen Burnie, Maryland
Supervisor, Pharmacy Claims
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Johns Hopkins Health Care,
Glen Burnie, MD
Requisition # 159217
Day Shift
Full Time (40 hours)
Weekend Work Not Required
Johns Hopkins employs more than 20,000 people annually across our health system. Upon joining Johns Hopkins, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join an employer that is a leader and innovator in the healthcare field.
Reports to the Manager, Pharmacy Operations and is responsible for oversight of day to day operations of the pharmacy claims coordinator team. Plans and directs work flow and project assignments, supervises and coordinates work activities to achieve service level goals and productivity as required. Additional responsibilities include:
Coordinate resolution of complex customer service issues regarding pharmacy services and serves as resource to Pharmacy Claims Coordinators on issues that require additional assistance
Training and evaluation of staff, compliance monitoring and productivity reporting.
Works with management to develop policies, procedures, and business work plans for the team
Direct responsibility of pharmacy coordinators, including management of daily workflow and staff results by communicating job expectations, planning work, monitoring performance and appraising job results
Responsible for coaching, performance management of pharmacy coordinators, initiating, coordinating, and enforcing systems, policies and procedures
Uses prior-authorization Turn Around Time, quality assurance measures, and phone reports to analyze staffing needs and department workflow procedures in order to improve member and provider experience
Follows through timely with resolution, implementation and evaluation to internal and external partners
Requirements:
High school diploma or equivalent. Associate’s Degree preferred
5 years of managed care pharmacy experience in a prior-authorization/call center setting
2 years of previous experience in a supervisory capacity
2 years of previous experience of intensive PBM interaction
Knowledge of Pharmacy Benefit Management and/or Health Insurance Industry related to customer support
Knowledge of pharmacy benefit designs within a managed care setting
Demonstrated knowledge of managed care concepts and principles of call center operations
Comprehensive and expert understanding of an inbound call center providing customer service and associated functions, such as call center metrics and reporting requirements
Understanding of medical terminology claims codes
Knowledge of Managed Care pharmacy claims processing, both online and via HCFA or CMS claim forms
Excellent interpersonal skills necessary to handle sensitive and confidential information, and to interact with a diverse patient population, providers and staff
Excellent administrative/organizational skills; advanced analytical ability required in order to gather and interpret data, and resolve moderately complex problems
Excellent leadership skills, including the ability to prioritize, problem-solve and multi-task in a fast-paced environment
Certified Pharmacy Technician preferred
Experience with ACD phone systems and pharmacy prior-authorization work flow preferred
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.