2 director of pharmacy services jobs found in East Hartford, CT

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided. This is a hybrid position until fully trained. Training will be full-time onsite. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned   KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines Proficient...

The Bill Review Supervisor is responsible for the supervision of all operations within their designated department. This position functions as a member of the Bill Review Department leadership team, ensuring optimum team performance by providing exemplary support and assistance to achieve the organizational goals of excellent customer service of the bill review department and of CorVel. This is a Hybrid role. In office full time for training, then hybrid once fully trained. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Directs a team of employees in their day-to-day operations and the quality of services provided, focusing on production, timeliness, and quality of bill review performance Establishes employee performance goals and follow-up to ensure employees are achieving goals, providing encouragement, training, and coaching as needed Evaluates and maintains appropriate staffing levels to ensure work is completed within internal and external customer turn-around time...