Adjudication Specialist

About the Role

Upperline Health is seeking a skilled Adjudication Specialist to join our team. As a key member of our pharmacy team, you will be responsible for centrally adjudicating pharmacy claims for patients receiving medication in our clinics.

Key Responsibilities

• Use Upperline's pharmacy software to manage a centralized queue of prescriptions from all of our locations
• Add a patient's pharmacy benefits to their profile and transmit claims
• Process all prescriptions through the patient's pharmacy benefits
• Communicate adjudication outcome when necessary with front desk staff in the clinic who are dispensing medication to patients
• 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

Requirements

• 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 Upperline's values of empathy, collaboration, and respect

What We Offer

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience. We offer a comprehensive benefit package, including medical, dental, and vision, 401(k), and PTO.