Pharmacy Claims Adjudication Specialist

4 weeks ago


Lakeland, Florida, United States WELLDYNE Full time
Job Summary

We are seeking a highly skilled Pharmacy Claims Adjudication Technician to join our team at WellDyne. In this role, you will be responsible for updating prescription orders, performing routine pharmacy functions, and ensuring accurate insurance information for correct adjudication.

Key Responsibilities
  • Update prescription orders following all pharmacy procedures and guidelines
  • Perform routine, professional pharmacy functions
  • Respect and maintain confidentiality guidelines of HIPAA
  • Follow and aid in enforcement of all company policies and procedures
  • Answer emails in a timely and accurate manner
  • Responsible for orders in failed claims and high co-pay queue
  • Ensure insurance information is accurate for correct adjudication
  • Accountable for checking patient history for refill too soon, increase/decrease of dose, and duplicate scripts
  • Ensure all prior authorizations are started in a timely and accurate manner
Requirements
  • High School Diploma or equivalent
  • Registered Pharmacy Technician with the State of Florida
  • Preferred - national certification (CPhT)
  • One year minimum of pharmacy experience
  • Knowledge of health insurance plans
  • Familiarity with Microsoft Word, Excel, and Outlook
What We Offer
  • Medical, Dental, and Vision Benefits
  • Medical Savings Account Options with Company match
  • 401K after 90 days of employment
  • Employee Assistance Program
  • Life and Supplemental insurance
  • Educational Reimbursement
  • Paid Time Off
Work Environment

This position is in a typical office environment which requires prolonged sitting and standing in front of a computer.

In addition, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment.

This position may be required to work long hours.



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