Pharmacy Claims Adjudication- Supervisor

We need to output HTML fragment with sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections if posting has real specific content. Let's parse the posting. - Title: Pharmacy Adjudication Supervisor (not repeated as heading). - About the role: There's description: "Onco360 Pharmacy has a need for qualified candidates to fill our role of Pharmacy Adjudication Supervisor. This is an excellent opportunity to join our company and help with our expanding Specialty Pharmacy program! This is a full-time position, Monday to Friday 9:30 am to 6:00 pm EST. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth." That's about the role/company. Could be "About the role" or "About the company". We'll use "About the role". It's substantive. - Responsibilities: The paragraph after "The Pharmacy Adjudication Supervisor is responsible for all aspects of pharmacy claims adjudication..." then "Adjudication Supervisor Essential Functions:" then bullet list of duties. So responsibilities section. - Requirements: Might be "Qualifications" includes Education/Learning Experience Required, Work Experience Required, Licenses/Certifications Required, Behavior Competencies Required. Could separate Qualifications and Skills. The posting has "Adjudication Supervisor Qualifications:" then Education/Learning Experience Required, Desired, Work Experience Required, Desired, Skills/Knowledge Required, Desired, Licenses/Certifications Required, Desired, Behavior Competencies Required. We can split: Qualifications (education, experience, licenses), Skills (skills/knowledge). But the instruction says use headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. They want both Requirements and Qualifications and Skills separate. We need to decide what goes where. "Requirements" could be mandatory requirements (education, experience, licenses). "Qualifications" could be desired qualifications? Or maybe they want Requirements for mandatory, Qualifications for desired? But they also have Skills separate. Let's map: - Requirements: Education/Learning Experience Required (High School Diploma or GED), Work Experience Required (4+ years pharmacy or pharmacy adjudication or equivalent experience, previous leadership experience), Licenses/Certifications Required (Registration with Board of Pharmacy as required by state law). Possibly also Behavior Competencies Required? Those are more like soft skills; could go under Skills. - Qualifications: Desired: Associates or Bachelor’s Degree, Certified Pharmacy Technician, Specialty pharmacy experience; Desired: 5+ years pharmacy or pharmacy adjudication or equivalent experience, 1+ years supervisor experience, Specialty pharmacy experience; Desired: Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills; Desired: Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification. But there is overlap. Might be better to combine Qualifications and Skills? However instruction says we can have few substantive sections over many thin ones. We could combine Qualifications and Skills into one "Qualifications" section that includes both required and desired qualifications and skills. But they also have separate headings for Qualifications and Skills. We need to decide based on content. Let's see if there is distinct "Skills/Knowledge Required" list: NDC medication billing, PBM and medical contracts, healthcare audit experience, knowledge of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, excellent interpersonal skills, able to work with all levels of management and staff, vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication, advanced typing, math and analytical skills. Desired: Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills. That's clearly skills/knowledge. Thus we can have: - Responsibilities: list of duties. - Requirements: mandatory education, experience, licenses. - Qualifications: desired qualifications (education, experience, certifications) maybe. - Skills: skills/knowledge required and desired. - Benefits: list of benefits. - Pay: salary range and sign-on bonus. - Schedule: Monday to Friday 9:30 am to 6:00 pm EST. We also have About the role. Now ensure we don't include boilerplate like EEO etc. Not present. We must not repeat job title as heading. We must not include Job ID/requisition numbers. We must preserve all substantive information. We must not invent or summarize away detail. We must not include sections with filler like "commensurate with experience". We have actual salary range: "Salary range starting at $60k and up depending on experience". That's specific enough for Pay section. Sign-On Bonus: $5,000 for employees starting before October 31, 2026. Include in Pay. Benefits: list: Medical; Dental; Vision; 401k with a match; Paid Time Off and Paid Holidays; Quarterly Incentive Bonuses; Tuition Reimbursement; Company paid benefits – life insurance; and short and long-term disability. We need to format as

• for any list. Now produce HTML. Structure:

  About the role

  ... (prose)

  Responsibilities

  • ... each duty
  We need to extract each duty from the responsibilities paragraph. Responsibilities paragraph: "The Pharmacy Adjudication Supervisor is responsible for all aspects of pharmacy claims adjudication, accuracy of pharmacy claims, resolution of third-party rejections, coordination of benefits, and patient outreach regarding any delay in medication delivery due to insurance claim rejections. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members. Adjudication Supervisor Essential Functions: Supervises adjudication staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff. In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication.Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays.Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. Document all prior authorization information in patient profile.Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed. Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards." We need to split into list items. Could break at each sentence after "Adjudication Supervisor Essential Functions:" but we can just list each distinct duty as a bullet. Let's extract bullet points: - Responsible for all aspects of pharmacy claims adjudication, accuracy of pharmacy claims, resolution of third-party rejections, coordination of benefits, and patient outreach regarding any delay in medication delivery due to insurance claim rejections. - Provide quality control by routinely examining cases completed by team members. - Supervises adjudication staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. - Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues. - Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills. - Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. - On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff. - In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels. - Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting. - Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication. - Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. - Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. - Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays. - Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. - Document all prior authorization information in patient profile. - Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed. - Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws. - Contributes to team effort by accomplishing related tasks as needed and other duties as assigned. - Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. That seems comprehensive. Now Requirements section: mandatory education, experience, licenses. Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Knowledge of insurance and applicable regulations Work Experience Required: 4+ years pharmacy or pharmacy adjudication or equivalent experience, previous leadership experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law We could also include Behavior Competencies Required? Those are more like soft skills; but they could go under Skills. We'll keep them under Skills. Thus Requirements list: - High School Diploma or GED. - Previous experience in pharmacy, medical billing, or benefits verification; knowledge of insurance and applicable regulations. - 4+ years pharmacy or pharmacy adjudication or equivalent experience