Pharmacy Adjudication Specialist

2 weeks ago

Indianapolis, Indiana, United States Innovative Rx Us Holdings, Inc. Full time
Job Title: Adjudication Pharmacy Technician

Young at Heart Pharmacy is seeking a motivated and customer-oriented individual to join our team as an Adjudication Pharmacy Technician.

Job Summary:

The Adjudication Pharmacy Technician will be responsible for ensuring prescriptions are dispensed to eligible patients and billed properly in accordance with their benefit plan. This role requires strong communication and problem-solving skills, as well as the ability to work well under pressure.

Responsibilities:
  • Perform billing duties as needed
  • Understand the pharmacy front-end process and perform point of sale functions (adjudication)
  • Contact payors and/or other outside agencies to verify information and resolve common, non-clinical problems
  • Run weekly billing reports
  • Obtain accurate billing and resident information, and rebill and resolve unpaid claims through adjudication
  • Re-bill and reconcile all incorrectly billed, non-clinical third-party denials
  • Identify and resolve and process denied claims in a timely manner
  • Document all communication concerning denied claims and any resolution communicated to facility or physicians
  • Obtain Prior Authorizations and non-covered forms
  • Obtain Part B documentation
  • Assist with billing DME supplies on line (Medicaid)
  • Resolve Hospice denials and communicate to Hospice nurses any denied claims
  • Adhere to and demonstrate mastery of current operating procedures
  • Use DocuTrack skills to locate specific documents and fax documents to facilities and/or for audit purposes
  • Stay in line with End of Month processes and deadlines
  • Ensure customer requests are handled quickly and professionally
  • Communicate effectively with customers to resolve billing inquiries
  • Communicate effectively with third party payors to resolve denied claims
  • Complete and verify pricing requests for customers
  • Direct specific inquiries to the appropriate team / individual
  • Maintain a positive, pleasant demeanor with all customers
  • Utilize robust problem-solving and people skills, patience, and telephone etiquette
  • Document customer issues using CPAS form and communicate to management
  • Work with Billing/Collection Managers on special projects as needed
Qualifications:
  • Active pharmacy technician license from the Indiana State Board of Pharmacy preferred
  • Previous pharmacy experience extremely valuable and desired
  • At least 1 year of billing experience
  • Proficient in Microsoft word and Excel
Working Conditions:

This position requires sitting for extended periods of time. Operating a desktop keyboard and mouse. Communicating with employees, patients, caregivers, and physicians by phone, fax, and email in a courteous and professional manner.

WE PROUDLY OFFER:
  • (Primarily) Monday - Friday Day Shift
  • Closed for 6 Paid Holidays
  • 14 Days of PTO in the first year
  • Multiple Healthcare Plans (including one at no-employee cost)
  • Dental and Vision Coverage
  • Free Life Insurance
  • Supplemental Insurance Plans
  • 401(k) Retirement Plan with a generous company match
  • Simple IRA
  • Medical and Dependent Care Flex Spending Accounts
  • $150 Initial Scrub Allowance, $50/year Continued Allowance
  • Onsite workout facility

Join us at Young at Heart Pharmacy and become a valuable member of our dedicated team committed to providing exceptional customer service in the healthcare industry.

Apply now and be part of our mission to make a difference in the lives of our patients and community.

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

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