Pharmacy Adjudication Technician

3 weeks ago


Charleston, United States Pharmacy Solutions Group Full time
Pharmacy Solutions Group - West Virginia -

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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