Johns Hopkins Medicine Pharmacy Claims Coordinator in Glen Burnie, Maryland

Pharmacy Claims Coordinator

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Johns Hopkins Health Care,
Glen Burnie, MD
Requisition # 156440
Day Shift
Full Time (40 hours)
Weekend Work Not Required

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, 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 those who are leaders and innovators in the healthcare field.

The Pharmacy Claims Coordinator reports to the Pharmacy Claims Coordinator Supervisor, and will assist members, physicians, pharmacist, and internal staff with eligibility issues, non-formulary overrides, claims adjudication and reimbursement issues in accordance with member’s benefit plan. This individual will also coordinate resolution of customer service issues regarding pharmacy services including, but not limited to pharmacy benefits and claims processing. As well as assist clinical staff by providing information relevant for clinical reviews.

Requirements:

  • High school diploma

  • 2 to 3 years of pharmacy claims adjudication and pharmacy benefit interpretation experience in a managed care environment; At least 3 years’ experience as a retail Pharmacy Technician and 1 year experience as a call center representative or claims examiner may be substituted

  • Knowledge of prescription drug products and Over The Counter (OTC) drugs, familiarity and ability to use pharmacy reference books

  • Knowledge of medical terminology claims codes

  • Knowledge of Managed Care pharmacy claims processing

  • Excellent interpersonal skills necessary to handle sensitive and confidential information, and to interact with a diverse patient population, providers and staff

  • Strong PC and software application skills

  • Experience with data entry

  • Excellent administrative/organizational skills

  • Advanced analytical ability is required in order to gather and interpret data , and resolve moderately complex problems

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.