Claims Supervisor jobs in Pittsburgh, PA

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. 

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.   

We are seeking team members who:

Are inspired and compassionate problem solvers;

Produce high quality work; 

Thrive in the excitement of the ever-challenging environment of modern medicine; and 

Are committed to achieving superior health outcomes for people living with rare and devastating diseases. 

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.  

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location: Pittsburgh, PA

Job Classification: Exempt

Job Status: Full-time; Hybrid

Reports to: Director, Revenue Reconciliation.

Purpose:

The Claims Supervisor oversees staff, checks for accuracy and quality of the team. Manages all operational and financial aspects of enrolling, billing, collection, and accounting for the money’s due from insurances and patients/members for their specialty medications.  

Responsibilities:

• Trains staff on the functions including but not limited to enrolling patients, understanding accounts receivable, and patient’s balance.
• Teaches staff on how to verify patient pharmacy coverage & processing information.
• Manages patient claims for prescription drug and medical benefits in relation to providing excellent specialty pharmacy care.
• Communicates with Claims Analyst to assure patients are being appropriately charged and insurance companies are being appropriately billed.
• Assists hiring and training to ensure the associate’s success in the job function.
• Supports management with regularly scheduled training classes with staff to ensure staff is abreast of all new therapies, drugs, and any new changes.
• Additional projects and activities as assigned.
• Opens communication within all departments and provides feedback to ensure positive results for patients, payors and PANTHERx.
• Works with Management to identify any negative margins at a drug/patient/payor level regarding adjudicated and non-adjudicated claims.
• Attends staff meetings and on occasion may lead a staff meeting.
• Other duties as assigned.

Required Qualifications:

• High school diploma or general education degree (GED).
• Strong written and verbal communication skills necessary to convey ideas professionally and effectively.
• Ability to understand and act on basic business principals of AR.
• Prioritization of daily tasks and focus on company goals.
• Ability to multitask.
• Proficient with EDS billing systems, Excel and Word.
• Minimum 6 years’ experience with medical and prescription insurance authorization.
• Licensure Required: N/A.

Preferred Qualifications:

• Experience or knowledge within the healthcare industry, particularly mail order or specialty pharmacy.
• Experience with CPR .

Work Environment:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function of the job.

Benefits:

Hybrid, remote and flexible on-site work schedules are available, based on the position.  PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!   Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.  Of course we offer paid holidays too!

Equal Opportunity:

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.