Manager of Network Pharmacy Claims and Accounts Receivable

Manager of Network Pharmacy Claims and Accounts Receivable

The Manager of Network Pharmacy Claims and Accounts Receivable oversees the daily operations of the Healthcare Revenue Cycle team to ensure appropriate and maximum cash collected.

What You’ll Do

• Oversee a team that provides direct support to pharmacy operations by ensuring all prescriptions are adjudicated through third party payors prior to dispensing
• Pre-adjudicate prescriptions through the pharmacy’s pharmacy management system(s) utilizing NCPDP standard transaction sets
• Respond and resolve pre-adjudication rejections including developing processes and procedures to ensure assurance of payment for all prescriptions dispensed along with coordinating with the clinical team to maintain a clinically acceptable level of continuity of care
• Support processes to ensure that prescribers and patients are notified and flagged for any prescriptions that require prior authorization
• Coordinate patient receivables processing end to end including invoicing, receiving patient payments, and monitoring of aging receivables
• Partner with the payment reconciliation team to ensure that third party payments are correctly posted to transactions
• Participate in strategic initiatives to provide scalable support to LTC and retail business growth among multiple pharmacy sites
• Utilize Key Performance Indicators (KPIs) to Identify and develop continuous process initiatives to improve cash collection payments and velocity
• Provide effective leadership to members of their direct reports including training, coaching, and career development initiatives

What You’ll Need to Succeed

• At least 5 years of direct experience in insurance of healthcare reimbursement, collections, billing, and claims verification management.
• Leadership experience and ability to think strategically
• Certified Pharmacy Technician a plus
• Bachelor’s Degree or equivalent experience required
• Strong negotiation skills together with problem recognition and resolution skills
• Strong computer skills, including experience with databases, Windows based applications and A / R related software support systems
• Professionalism with strong verbal, written and interpersonal communication skills
• Strong recruitment skills which facilitate a clear understanding of selection criteria
• Ability to deal with external customers enthusiastically and with professionalism
• Ability to effectively present information and respond to questions from both internal and external customers
• Ability to deal with difficult collection situations and resolve issues delaying / preventing payments from carriers, plan sponsors and / or patients directly
• Ability to handle multiple tasks and complex reimbursement issues
• Ability to analyze and assess emerging collection / risk assessment trends and provide insightful, detail-oriented reporting on those trends

Make A Difference With AWP

Advanced Wellness Pharmacy (AWP) is proud to be a leading provider in multi-dosed medication management serving a high-risk patient population .

At AWP we believe in our service, but it’s the people who make it a great place to work. We value our employees and strive for a culture of teambuilding, open mindedness, and fun.

If that sounds like something you’d like to be part of, we’d love to hear from you! Your compensation will include a competitive salary, generous benefits, and opportunities for growth and development.

AWP is an Equal Opportunity Employer. AWP does not discriminate on the basis of race, creed, color, religion, national origin, sex, sexual orientation, gender identity, age, physical or mental disability, or any other basis covered by appropriate law.

All employment decisions are made on the basis of qualifications, merit, and business need. AWP is committed to providing reasonable accommodations for qualified individuals with physical and mental disabilities in our job application procedures.

If you need assistance or an accommodation due to a disability, you may contact us at We will make a determination on your request for reasonable accommodation on a case-by-case basis.