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Job Description G ENERAL P URPOSE

To provide knowledge of Medicare, Medicaid, Prescription Drug Plans (PDP’s) and Third Party Insurances to appropriate health care professionals, advising resident and appropriate parties on PDP options available, enrolling and applying for low income subsidy if applicable. Ensures that all adjudicated prescriptions leaving the pharmacy have received a paid response or the claim has been resolved to bill to the next appropriate payor.

Performs and/or oversees the completion of all routine and tasks, including but not limited to:

+ + Resolution of rejections, denials and PA’s associated with all adjudicated Medicaid, Medicare D or Private Insurance claims.

+ Serves as the Communication liaison regarding medication or resident coverage issues with; Administrators, DON’s, Admissions, Social Services, Consultant Pharmacists, Internal Pharmacists, Data Entry, Business Office staff, Resident’s, Responsible Parties, Physicians, Medical Directors and PDP’s/Insurance plans.

+ Advises resident and appropriate parties on PDP options available.

+ Counsels customers and appropriate parties on enrolling, and applying for low income subsidy if applicable.

+ Provides daily and weekly communications with facilities regarding outstanding coverage issues and works to find and assist in resolving coverage issues in a timely manner.

+ Accepts ownership and accountability for the successful completion of assigned functions and achievement of goals.

+ Strives for compliance by all staff with internal controls and state and federal regulations.

+ Participates in the development and successful implementation of plan(s) of improvement as indicated, recommended and/or required by Supervisor, Director, or any other corporate or regulatory compliance consultant. Communicates progress toward goals and ongoing obstacles to supervisor and company management team, verbally and/or in writing or as dictated.

+ Provides training to other staff that is necessary to successful job performance, consistent with company standards and expectations, and facilitates cross-functional awareness and proficiencies.

Q UALIFICATIONS

+ High school diploma or equivalent.

+ Knowledge of Medicare, Medicaid, Prescription Drug Plans (PDP’s) and Third Party Insurances.

+ Strong organization skills including the ability to prioritize and manage multiple tasks in a dynamic environment.

+ Strong analytical skills; ability to quickly identify problems and find effective solutions

+ Strong written and oral communication skills.

+ Must have knowledge of office machines and equipment.

+ Basic computer skills preferred; experience with Microsoft Excel and Word.

+ Ability to make independent decisions.

+ Ability to understand and interpret claim information data.

+ Ability to work and produce results under pressure

+ Ability to effectively and harmoniously interact with facility, management and other employees at all levels; promotes teamwork and professionalism

+ Must be capable of maintaining regular attendance

+ Must be dependable and able to work with minimal supervision

+ Must be at least 18 years of age

+ Must be able to speak, read, write, and understand English

+ Must be capable of performing the E SSENTIAL J OB F UNCTIONS and P HYSICAL AND S ENSORY R EQUIREMENTS FOR A LL J OB F UNCTIONS as outlined below.

EOE

Requirements