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Pharmacy Adjudication Specialist
4 weeks ago
Position: Pharmacy Adjudication Specialist Location: Louisville, KY Job Id: 3437 # of Openings: 1 We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. This will be a Full-Time position, Monday to Friday, 11:30am to 8pm EST. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $20.00 an hour and up We offer a variety of benefits including: 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits – life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy, ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections. Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays. Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible). Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Documents and submits requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities: Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication. Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience. Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience. Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience. Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Desired: Knowledge of Foundation Funding, Specialty pharmacy experience. Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law. Desired: Certified Pharmacy Technician (PTCB). Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills. #J-18808-Ljbffr
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Pharmacy Adjudication Specialist
3 weeks ago
Louisville, United States Onco360 Full timeWe are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. This will be a Full-Time position. There are two shifts available: Monday to Friday, 11:30am to 8pm EST and 9:30am - 6pm EST. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology...
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Pharmacy Adjudication Coordinator
10 hours ago
Louisville, Kentucky, United States Onco360 Full timeJob SummaryWe are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy. As a Pharmacy Adjudication Specialist, you will play a critical role in ensuring the accurate and timely adjudication of pharmacy claims, resolving third-party rejections, and providing exceptional customer service to patients and healthcare...
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Clinical Pharmacy Specialist
5 hours ago
Louisville, Kentucky, United States Baptist Health Full timeJob Summary:Baptist Health is seeking a highly skilled Clinical Pharmacy Specialist to join our team. As a key member of our healthcare team, you will play a vital role in providing exceptional patient care and services.Key Responsibilities:Communicate effectively with physicians and other healthcare professionals to ensure seamless patient care.Enroll...
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Specialty Pharmacy Claims Analyst
1 week ago
Louisville, Kentucky, United States Onco360 Full timePosition Overview:We are currently looking for a Pharmacy Claims Specialist to join our dynamic team at Onco360. This role is essential in ensuring the smooth adjudication of pharmacy claims within our specialty pharmacy environment.Work Schedule:This is a Full-Time position with a standard workweek from Monday to Friday, focusing on evening hours.Key...
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Pharmacy Packaging Specialist
3 days ago
Louisville, Kentucky, United States A-Line Staffing Solutions Full timeJob OverviewA-Line Staffing Solutions is currently seeking a Pharmacy Packaging Specialist. This role offers the opportunity to work with a reputable Fortune 500 organization, providing a pathway for career advancement. The position is full-time, requiring 40+ hours per week.Compensation and BenefitsThe hourly wage for this role is $20.00.Full-time employees...
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Pharmacy Authorization Specialist
1 week ago
Louisville, Kentucky, United States BrightSpring Health Services Full timePHARMACY AUTHORIZATION SPECIALISTCompany OverviewBrightSpring Health Services is dedicated to providing exceptional healthcare solutions tailored to the needs of our clients. We operate in a non-retail pharmacy environment, focusing on the pharmaceutical requirements of long-term care and senior living facilities. Our organization is experiencing significant...
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Transplant Pharmacy Clinical Specialist
2 days ago
Louisville, Kentucky, United States UofL Health Full timePosition Title: Transplant Pharmacy Clinical SpecialistOrganization: UofL HealthWork Schedule: Full Time, Day ShiftThe Transplant Pharmacy Clinical Specialist is responsible for delivering expert pharmaceutical care aimed at enhancing medication efficacy and improving patient health outcomes. Key duties encompass the assessment of medication orders,...
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Pharmacy Operations Specialist
1 week ago
Louisville, Kentucky, United States CPS Solutions , LLC Full timePosition Title: Pharmacy Operations Specialist - Per DiemCompany: CPS Solutions, LLCLocation: Louisville, KentuckyAs a per diem, nonexempt Pharmacy Operations Specialist with CPS Solutions, LLC, you will support various pharmaceutical functions under the guidance of a licensed pharmacist. Key Responsibilities:Prepare, dispense, and replenish medications as...
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Pharmacy Trainer
2 months ago
Louisville, United States Knipper Health Full timeOverview YOUR PASSION, ACTIONS & FOCUS is our Strength Become one of our Contributors Join the KnipperHEALTH Team! POSITION SUMMARY:The Pharmacy Trainer conducts program and system training, as well as, quality assurance for the assigned program(s). The Pharmacy QA/ Trainer will assist in the deployment, adherence, and execution of the training plan and...
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Pharmacy Trainer
2 months ago
Louisville, United States Knipper Health Full timeOverview : YOUR PASSION, ACTIONS & FOCUS is our Strength Become one of our Contributors Join the KnipperHEALTH Team! POSITION SUMMARY: The Pharmacy Trainer conducts program and system training, as well as, quality assurance for the assigned program(s). The Pharmacy QA/ Trainer will assist in the deployment, adherence, and execution of the training plan and...
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Pharmacy Customer Support Specialist
3 days ago
Louisville, Kentucky, United States CornerStone Staffing Full timePosition Overview: We are seeking a dedicated Pharmacy Customer Support Specialist to join our team at CornerStone Staffing. This role is essential in providing exceptional service to our clients. Key Responsibilities: Manage incoming and outgoing calls with patients, caregivers, and healthcare providers.Deliver outstanding customer service, ensuring a...
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Clinic Specialty Pharmacist
4 weeks ago
Louisville, United States Baptist Health Full timeJob Description:Baptist Health is looking for a Clinic Specialty Pharmacist (Rheumatology) to join our team at 2800 Breckenridge Lane, Louisville, KY.Communicate with physicians and other clinicians as necessary to facilitate exemplary service for new and existing clinic patients.Enroll specialty patients into the program by assisting with recruitment of...
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Client Support Specialist
4 days ago
Louisville, Kentucky, United States PCA Pharmacy Full timePosition OverviewThe Customer Service Representative at PCA Pharmacy plays a vital role in ensuring that our clients receive outstanding support and assistance. This position involves engaging directly with our customers and vendors, including managing communications with delivery services.Key ResponsibilitiesDeliver exceptional customer service to all PCA...
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Pharmacy Support Specialist
5 hours ago
Louisville, Kentucky, United States Onco360 Full timeJob SummaryWe are seeking a highly motivated and detail-oriented Pharmacy Intern to join our team at Onco360 Pharmacy in Louisville, KY. As a Pharmacy Intern, you will play a vital role in supporting our pharmacists and patients by providing exceptional customer service, maintaining accurate records, and ensuring the safe and efficient dispensing of...
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Client Support Specialist
1 week ago
Louisville, Kentucky, United States PCA Pharmacy Full timePosition OverviewThe Customer Service Representative plays a vital role in ensuring customer satisfaction at PCA Pharmacy. This position is dedicated to delivering exceptional support to our valued clients.Key ResponsibilitiesEngage directly with customers and vendors, addressing inquiries and resolving issues efficiently.Facilitate communication with...
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Specialty Pharmacy Support Expert
14 hours ago
Louisville, Kentucky, United States EBlu Solutions LLC Full timeJob DescriptionOvervieweBlu Solutions LLC is seeking a highly skilled and experienced Provider Relations Support Specialist to join our team. As a key member of our Provider Relations Success Team, you will play a critical role in supporting patient access to care through the support of healthcare providers, pharmaceutical company representatives, and...
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Pharmacy Fulfillment Specialist
1 week ago
Louisville, Kentucky, United States Baptist Health Full timePosition Overview:Baptist Health is seeking a dedicated Pharmacist for our Central Fulfillment team, operating within the Central Pharmacy.This role encompasses a variety of responsibilities related to the distribution of medications and the fulfillment of prescriptions, including:Receiving and screening incoming medicationsReviewing and verifying...
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Pharmacy Support Specialist
1 week ago
Louisville, Kentucky, United States CornerStone Staffing Full timeCompany Overview: CornerStone Staffing is seeking a dedicated Pharmacy Technician to support our operations in a dynamic pharmacy environment. Position Summary: The Pharmacy Technician plays a crucial role in assisting healthcare professionals and patients with various pharmacy-related tasks. This position involves data entry, managing phone communications,...
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Licensed Pharmacy Technician
2 weeks ago
Louisville, KY, United States PharMerica Full timeJoin PharMerica, a closed-door pharmacy, and focus on fulfilling the pharmaceutical needs of long-term care and senior living clients in a non-retail environment. Benefit from our high-growth organization, offering advancement opportunities for career progression. Shift: _Days,_ Monday - Friday, 11:30 am to 8 pm and rotating weekends Pay: $19/hr...
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Team Lead, Pharmacy
2 months ago
Louisville, United States Knipper HEALTH Full timeOverview: YOUR PASSION, ACTIONS & FOCUS is our Strength Become one of our Contributors Join the KnipperHEALTH Team! POSITION SUMMARY: The Team Lead, Pharmacy, would have the responsibility to monitor team activity and effectiveness, manage queues in the Call Center Software as unexpected increases/decreases in volumes dictate, update FAQs as required,...