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Mutual of Omaha Careers

Pharmacy Coordinator Supervisor - Omaha, Ne

Apply now Job no: 497582
Work type: Full Time Regular
Location: Nebraska
Grade: C19
Reports to Manager: Michelle Anderson
Recruiter: Amanda Yates
Categories: Leadership, Claims/Claims Processing

Mutual of Omaha is seeking a Pharmacy Coordinator Supervisor to join our team! This role will supervise and coach staff that are responsible for daily Medicare pharmacy rejected claims and transition claims oversight. Responsibilities will also include performing daily rejected claims review, monitoring staff interventions, using knowledge of brands and generics to identify appropriate pharmacy claims requiring intervention and oversight process with staff to keep claims resolution timely. As well as, training staff of all updates and formulary changes that impact the process and identifying and implementing process updates and improvements.

WHAT YOU'LL DO:

  • Oversees staff performing rejected claims oversight and monitoring.
  • Provides required maintenance to upkeep rejected claims process including but not limited to letter review, updating drug lists used in automated coded rules and reviewing claim samples to monitor automated claim sorting rules are working correctly.
  • Performs monitoring of staff documentation, decision making and calls.
  • Regularly reviews formulary and coding changes and trains staff on changes.
  • Responsible for coordinating identified issues with the PBM and plan management.
  • Maintains and updates policies and procedures related to rejected claims and transition oversight and process.
  • Directs, organizes, staffs, leads and controls activities including: Planning projects; interviewing, selecting and training of direct reports; monitoring and appraising performance of direct reports to hold them accountable for end results, including human resource management; coaching and motivating direct reports; administering disciplinary action as needed; administering compensation to direct reports; ensuring that the segment complies with affirmative action guidelines.
  • Develops and maintains an engaged and accountable workforce. Develops and maintains a fair and equitable working environment.
  • Performs rejected claims process investigating rejected Medicare pharmacy claims.
  • Sorts claims according to outlined processes to ensure interventions occur when appropriate, such as separating non-formulary rejections into pharmacy interventions (brand/generic use resolves the claim) or prescriber interventions (authorization is required).
  • Validate precluded provider rejections against available precluded provider data.
  • Performs research in member's pharmacy claim profile to identify the reason for claim denials.
  • Appropriately documents details of claim investigations.
  • Makes phone calls to pharmacies to assist pharmacy staff with processing member prescriptions. Calls may include assisting with claims related to long term care, quantity limits, ESRD, determining drug's use to establish if it will be covered under Medicare Part B or Part D, correcting prescriber NPI/DEA issues, opioid related edits and information collection, age indictors submitted, NDC related rejections and protected class drugs.
  • Refers pharmacy staff to appropriate PBM resources when required, such as for BvD determinations.
  • Places phone calls to provider offices to initiate interventions to ensure timely claims resolution. Calls may include assisting with claims involving drug utilization review edits, hospice, quantity limits, contract related rejections.
  • Pushes researched claims to pharmacy or provider fax when appropriate.
  • Transition claim and letter report review and monitoring.
  • Updating provider and member contact information to ensure timely transition letter delivery.
  • Verify that transition logic is working correctly by reviewing transition start dates and enrolment information loaded in the member's pharmacy claim profile.

ABOUT YOU:

  • Help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
  • Able to work remotely and have access to high-speed internet.
  • BS or BA in Healthcare or related field or equivalent work experience.
  • Ability to handle multiple high priority projects with competing deadlines.
  • Effective planning, organizational and decision-making skills.
  • Ability to analyze, interpret and utilize significant data to make sound recommendations and/or business decisions.
  • Ability to interpret and apply laws and regulations.
  • Strong knowledge and experience in utilizing a personal computer to include various software packages and databases, including
  • Microsoft Word, Excel, and PowerPoint.
  • Ability to work independently with minimal supervision.
  • Strong written and verbal communication and interpersonal skills.
  • National Pharmacy Technician Certification or Certified Pharmacy Technician (CPhT),
  • Strong organizational skills and the ability to prioritize appropriately.

VALUABLE EXPERIENCE:

  • Experience in health care industry in related field preferred.
  • Strong customer service skills, call center experience preferred.
  • Medicare, claims processing auditing experience, PBM and/or pharmacy audit experience preferred.
  • Training experience preferred.
  • Project management preferred.
  • PBM experience a plus.
  • Medicare Advantage and/or Prescription Drug Plan experience preferred.

WHAT WE CAN OFFER YOU:

  • A diverse workplace where associates feel a sense of belonging
  • An organization that feels like a small, close-knit community and has the strength of a Fortune 500 company
  • Tuition reimbursement, training and career development
  • Competitive salary, incentives, 401(k), flexible work schedules and a healthy amount of time off

MUTUAL OF OMAHA:

Mutual of Omaha serves more than 4.8 million individual product customers and 39,000 employer groups. Our legacy of stability creates an environment where every associate is encouraged to experiment, innovate and grow in their own unique career path.

From day one, you’ll have the tools to be your best self at work. Here you’ll do meaningful work and your talents will have a positive impact on peoples’ lives as we help our customers protect what they care about and achieve their financial goals.

Each associate is a unique contributor to creating a diverse, dynamic, thriving and inclusive workplace. We want you to become engaged … feel a sense of belonging … and contribute to the company’s exceptional future.

Join forces with a company that can AMPLIFY YOUR STRENGTHS AND EMPOWER YOUR CAREER.

For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.

Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.

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