Pharmacy Adjudication Technician

2 weeks ago

Cabin Creek, United States CommuniCare Advantage Full time

Pharmacy Adjudication Technician

Pharmacy Solutions Group is currently recruiting an Adjudication Technician to join our West Virginia team

Responsibilities:

* Responsible for adjudication of daily unit dose and non-unit dose claims
* Contacting insurance for proper overrides
* New Admits for assigned homes (MOP, group codes, tax group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
* Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.
* Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
* Welcome Packets - prepare Welcome Packet to all new PVT patients/families
* Receptionist will mail and Print the packet
* Ensure documents in ECM Billing folders are worked timely
* Ensure Emails to Billing Email are worked timely
* Authorizations - gaining approval from facilities and families on non-covered meds or medication requiring authorization
* Manage Monthly Adjudication of Cycle Batches/ Unit Dose Reject Batches
* Working assigned Customer Notes in a timely manner
* Adding Hospice and VA Med list
* Cubex Temp patients for LTC
* Work any BI-Call batches for homes
* Assist billing with rebilling/working open billing batches
* Communicate issues in preventing batches from being posted in a timely manner
* Assist with other projects as assigned

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