Adjudication Specialist

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**Adjudication Specialist**

* Nashville, TN

* Full Time

* Entry Level

Upperline Health launched in 2017 and is the nations leading comprehensive and coordinated lower extremity healthcare organization. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Georgia, Indiana, and Tennessee.

**Benefits**

Comprehensive benefit options include medical, dental and vision, 401(k) and PTO.

**About the Adjudication Specialist Role**

Upperline Health is seeking a **Patient Care Coordinator to adjudicate pharmacy claims for patients who are receiving their medication in our clinics.** This role will be based in the office connected to our compound pharmacy on **Metroplex Drive near Nashville International Airport.**

Recent studies have indicated that 40% of patients never pick up their prescriptions and are thus non-adherent to their care plans. Upperline Health operates in-office pharmacies in its clinics to offer patients the most convenient option for obtaining their prescriptions. Upperline is now in network with several large pharmacy benefit managers so that patients can use their pharmacy benefits to pick up their prescriptions. This role will centrally adjudicate all pharmacy claims for medication dispensed in our clinics. A successful candidate must thrive in a fast-paced environment and demonstrate compassion for patients, have great attention to detail, and communicate well with team members. Responsibilities will be varied, and candidates should be a multitalented, flexible problem solver who is also eager to execute an important process accurately and consistently.

**What you will do**

* Use Upperline's pharmacy software to manage a centralized queue of prescriptions from all of Upperline's locations

* Add a patient's pharmacy benefits to their profile and transmit claims

* Process all prescriptions through the patients' pharmacy benefits

* Communicate adjudication outcome when necessary with front desk staff in the clinic who are dispensing medication to patients; also available to answer any questions from patients about their benefits as it relates to their prescription

* Manage prior authorizations for prescriptions which require them

* Work with call centers for the pharmacy benefits managers (PBMs) when necessary to obtain a patient's pharmacy benefit information

* Manage network contracts with PBMs to ensure that Upperline continues to be able to process claims

**Qualifications of the Patient Care Coordinator**

* Background in pharmacy adjudication preferred but not required

* Experience with MDScripts software is a plus

* Associates or Bachelors degree preferred

* Motivated to own, improve, and execute on processes

* Self-starter with an entrepreneurial spirit, demonstrated problem solving skills, and flexibility to work in a fast-pace and evolving environment

* Excellent organizational skills, ability to multi-task and a proven work ethic

* Quick learner who is team-oriented and willing to dive in and get her/his hands dirty

* Possesses a strong customer service orientation and a desire to learn from and assist others

* Ability to communicate in an open and honest way that quickly builds trust and respect

* Embodies Upperlines values of empathy, collaboration, and respect

**Compensation**

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time

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