Medicare Claims Coordinator

Care Capital Management - Mechanicsburg, PA
Posted: March 14, 2020

Care Capital Management, servicing the Medicine Shoppe Pharmacies announces an anticipated opening for a caring and compassionate Pharmacy Medicare Claims Coordinator at our corporate headquarters in Mechanicsburg, PA.

Job Opening: Pharmacy Medicare Claims Coordinator

Location: 4999 Louise Drive, Mechanicsburg, PA

Status: Full time (35-40 hours per week)

As Pharmacy Medicare Claims Coordinator you will support our pharmacy teams by overseeing the accuracy of pharmacy claim billing to Medicare and Medicaid programs and ensuring compliance with beneficiary charts. Responsibilities include, but are not limited to:

  • Coordinate with pharmacies to ensure proper claim billing of supplies to Medicare B and secondary insurances
  • Serve as the liaison between physician and pharmacy to obtain medical chart documentation and approve medical necessity as related to the product being prescribed
  • Responsible for the appeals process and for reconciliation of Medicare claims, including billing to secondary, tertiary and to beneficiaries for copayments or deductibles
  • Responsible for claims processing to Highmark Navinet and Medicaid for incontinence supplies
  • Manage the compliance with Medicare beneficiary chart requirements meeting standards set forth by the Centers of Medicare & Medicaid Services (CMS) and Accrediting bodies
  • Responsible for keeping up to date with changes to the Medicare program including, Local Coverage Determination (LCD) policies, billing changes and reimbursement rates for product categories
  • Effectively communicate to pharmacy staff and provide training on changes related to the Medicare program

Qualifications

If you possess the following skills and experience and share our commitment to service, we invite you to apply by contacting us today:

  • Medicare and Medicaid program background including reading medical charts and HCPS coding required
  • General knowledge of and ability to use personal computers, word processing and spreadsheet software
  • Familiarity with applications such as Navinet and Promise a plus
  • Excellent oral and written communication skills
  • Ability to maintain a high level of accuracy in preparing data
  • Strong organizational & time management skills
  • Ability to build relationships with other team members

Because our customers are our first priority, we seek candidates who demonstrate exceptional integrity, care, compassion, empathy, and commitment in their work.

Prior to beginning work, successful applicants must complete a background check consisting of criminal records check, Medicare exclusions check, employment verification, education verification, drug test, licensure/certification verification, and DMV motor vehicle record check, as applicable.

 

Caring Service, Compliance Medication Systems, Teamwork

Operating as Medicine Shoppe Pharmacy, Care Capital Management (CCM) was founded in 1971 with a dedication to caring service. What makes us special is that we focus our attention and efforts on delivering personal retail service, long-term care, and institutionalized pharmacy. To learn more, visit our website at www.CareCapitalManagement.com.

We offer a comprehensive benefits package including medical, dental, vision, 401(k), life, disability, paid time off, paid holiday for eligible employees.

We are proud to be an Equal Opportunity Employer.


Care Capital Management

Care Capital Management

Mechanicsburg, PA

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