Reimbursement Officer III

4 weeks ago


Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
The State Office State Supported Living Center (SSLC) Division is seeking a Certified Pharmacy Technician/Reimbursement Officer to join an interdisciplinary team of professionals to provide clinical care to residents of the SSLC. As a Certified Pharmacy Technician/Reimbursement Officer, you will work with a dynamic group of staff and professionals who are dedicated to providing supports and services for individuals with intellectual and developmental disabilities. This is a team environment where staff clinicians collaborate to provide comprehensive care and services. To learn more about the SSLCs, see

The most important characteristic about SSLC employees is that we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence. Our vision statement is “Individuals served at State Supported Living Centers will experience the highest quality of life, supported through a comprehensive array of services designed to maximize well-being, dignity, and respect.”

The state of Texas offers many benefits to employees, including competitive salaries, career advancement, health and dental insurance, and paid vacation and sick leave. Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Reviews and researches rejected third-party claims taking appropriate action to resolve; Works backlog of denied claims for timely resubmission; Manages assigned duties keeping up-to-date and current on all claims; Workflow grid is cleared each cycle and meets productivity criteria; Identifies specific denials including new patient overrides; Completes and submits prior authorization forms for rejected claims; Follows all applicable government regulations including HIPAA; Responds to prescription drug plan audit requests; Maintains positive relationships with facility pharmacy staff; Assists facilities with prescription drug plan selection; Other duties as deemed necessary; and Ability to work both independently and as part of a team. Knowledge Skills Abilities:
Working knowledge of CMS guidelines in regards to Medicare Part D reimbursement. Thorough knowledge of medication dispensing systems and state and federal laws related to drug distribution. Knowledge of medical and pharmaceutical terms. Ability to communicate orally and in writing to diverse audiences. Ability to manage high volume workloads and meet deadlines. Skill in operating computers and applicable software.
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