Adjudication Technician I

4 weeks ago

Milwaukee, United States SERVE YOU RX Full time

**Serve You Rx** is looking for Certified Pharmacy Technicians to work as an **Adjudication Technician** in our Member Services department. As an Adjudication Technician you will be vital in making a difference in our members? lives and well-being. You will be working to find solutions, assist Serve You Rx members with their prescription orders and benefits, and work with a fun, diverse, and customer-focused team. This position is located behind our closed-door pharmacy that provides prescriptions to patients by mail, but it also opens the door for future growth and gives you the opportunity to make a real impact

**What You?ll Do**:
As the **Adjudication Technician**, you will be:

- Accurately processing patient prescriptions. Entering the prescription into the pharmacy management system and into the correct patient profile. Determining the fill date of the prescription. Submitting prepared prescriptions to the patient?s insurance and evaluate claim payment accuracy. Sending prescriptions to the pharmacist for review before fulfillment.
- Assisting with all inbound calls to include answering member mail order prescription questions.
- Creating new patient profiles in the pharmacy management system to include demographic information, allergy, and medical diagnosis history, over the counter medication history, and insurance information.
- Processing prescription refills to include creating an order, assessing any special requests for specific prescription fulfillment to ensure accurate filling and shipping, and sending the order to the pharmacist for review.
- Contacting prescribers to resolve prescription discrepancies to accurately process the prescription.
- Processing pharmacy order exceptions to include investigating failed claims, submission errors, and other order issues inhibiting the pharmacy from being able to process a prescription. Contacting patients to resolve discrepancies, start the prescription prior authorization process, and contact third party payers to obtain prior authorization status.
- Processing billing reports, audit cleanup reports, and profile cleanup reports.
- Assisting patients in obtaining manufacturer coupon cards to lower their copays and obtaining free blood glucose testing meters.
- Maintaining security of paper and electronic patient health information in accordance with regulations such as HIPAA and Serve You Rx policies and procedures.
- Performing other duties and responsibilities as required.

**Qualifications**:

- High school diploma or GED.
- At least six months experience working in a pharmacy completing prescription data entry tasks and having direct patient contact.
- One year of customer facing experience in a related field to include employee benefits and/or pharmacy/prescription drugs, or similar experience preferred.
- Previous computer experience and basic MS Office Professional experience.
- An active and valid Certified Pharmacy Technician license, licensed through the Pharmacy Technician Certification Board (PTCB) that is in good standing with no restrictions.

**Why Serve You Rx?**

Serve You Rx is a full-service pharmacy solutions provider based in Milwaukee, Wisconsin. We specialize in pharmacy benefit management, mail order services, and specialty medication management. For more than 35 years, Serve You Rx has been collaborating with benefit advisors, third-party administrators, and employers to design and deliver strategies that reduce prescription drug costs and improve consumer access to affordable and clinically appropriate medication therapies.

Serve You Rx is privately held, and our owned assets include our Specialty Pharmacy, mail order pharmacy, and member services call center. In addition to the great workplace culture, Serve You Rx offers generous benefits to include: medical, dental, vision, 401k, HSA, identity theft, and pet insurance, 18 days of paid time off in your first year. If working on site, we offer a newly remodeled and clean facility, easy on/off freeway access, plenty of free surface parking directly outside our facility doors, scenic walking trails, a wide variety of restaurants and shopping nearby, and food trucks in the park when weather permits.

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