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Pharmacy Billing/Reimbursement Mgr (Philly Area)

  • 1.  Pharmacy Billing/Reimbursement Mgr (Philly Area)

    Posted 05-18-2021 04:33 PM
      |   view attached
    Contract Pharmacy Services, located in Warrington, PA is seeking a pharmacy billing/reimbursement manager for our long-term care billing department. If you are aware of anyone that meets the attached criteria, please reach out to myself,, or our human resource dept 267-487-9007.

    Key Responsibilities

    This position is responsible for the management of departmental operations including, but not limited to:

    • Supervise Contract Pharmacy Services Billing Department in various duties, such as account management, communications with insurance providers, collections, payment posting, contract analysis, and billing functions.
    • Overseeing hiring and training of staff (includes facilitating training, on boarding and daily coaching/mentoring)
    • Responsible for daily workflow of claim adjudication, rejection resolution, and reimbursements issues to insure consistency with 3rd party Pharmacy Benefit Management (PBM) contracts
    • Oversight of facility census reporting to ensure accurate pharmacy billing
    • End of month preparation and distribution of facility and resident invoicing
    • Management of collection efforts and monthly meetings with Director of Finance in recommendations of bad debt write-offs
    • Work professionally and cooperatively with Facilities, Responsible Parties/Customers, Insurance carriers and all internal departments
    • Perform timely response to external 3rd party Audits by PBMs
    • Maintain professional internal and external relationships that reflect Contract Pharmacy Services Core Values
    • Efficiently manage customer complaints/disputes in respect of billing and collections
    • Manage staff performance by providing regular feedback, one-on-one meetings, and performance reviews
    • Project Management


    A successful candidate should have:

    • Proficiency in prescription claims billing, including the resolution of rejections (Medicare D, Medicaid, and Commercial 3rd Party Providers)
    • An in-depth knowledge of PBM pharmacy reimbursement methodologies
    • Knowledge of Medicare, Medicaid and other 3rd party insurance plans billing practices and regulations
    • Excellent interpersonal and communication skills, outgoing personality with a professional demeanor and positive attitude
    • Commitment to excellence with high quality service standards for customers
    • Strong time management and organizational skills; ability to effectively multitask and meet deadlines
    • Excellent attention to detail with exceptional follow-up, problem-solving and analytical skills
    • Exhibit courteous, compassionate, and respectful treatment of internal and external customers
    • Self-motivated, quick learner who works well independently as well as in a team setting
    • Strong work ethic with exemplary attendance record
    • Knowledge of HIPAA regulations and patient privacy rules


    • Perform all other duties as assigned or requested by the Director of Finance
    • Maintain patient confidentiality
    • Create a comfortable atmosphere for fellow employees by maintaining the CPS Code of Conduct

    Physical Demands

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk, hear, read, and write/type. This position is largely sedentary, thus requires sitting for long periods of time. 


    Required Education and Experience

    • 5 years of pharmacy billing experience including current working knowledge of billing and reimbursements for Medicare D, Medicaid, and 3rd Party Pharmacy Prescription Plans
    • Previous Long-Term Care pharmacy billing experience a plus
    • At least 3 years of experience managing 3+ employees
    • Experience in maintaining customer relationships and client communications
    • Proficient in all Microsoft Office applications, as well as billing office software
    • Framework and Sage 300 software a plus


    Kimberly Masson


    Billing Manager.docx   52 KB 1 version