Pharmacy Claims Specialist (Adjudication)

Medscript LTC Pharmacy is looking for an Adjudication Specialist to add to our Billing Department. This person is responsible for the timely resolution of daily insurance rejections to ensure accurate adjudication of claims. Remote work environment is available upon successful completion of training.

The available shift is:

• 7on/7off: Wednesday - Tuesday: 10pm - 8am

Primary Duties:

• Knowledge of long-term care pharmacy rules and regulations
• Communication with insurance companies to obtain accurate overrides
• Provide and maintain notification forms such as suggested alternatives, facility authorizations and non-covered
• Understand and adhere to facility financial policies and communicate follow up with facility representatives
• Send and maintain prior authorizations
• Complete cost out requests
• Input patient demographics including payer information for daily new admits & re-admissions
• Submit daily and cycle batches
• Resolve rejected claims timely based on priority
• Post completed batches
• Consistent communication with Pharmacists regarding alternatives and interchanges
• Knowledge of insurance formularies
• Completion of insurance audits

Miscellaneous Duties:

• Ability to work overtime if needed
• Other duties as assigned

Education:

• High School Diploma or equivalent required
• Indiana Pharmacy Technician License or Technician In-Training License required

Preferred Experience:

• Pharmacy
• Knowledgeable in all major insurance carrier reimbursement guidelines
• Experience with EMAR software
• General understanding of Excel and Microsoft Programs
• Experience with Cover My Meds portal

Work Traits:

• Demonstrates proficiency in keyboarding /computer use
• Intimate knowledge of federal and state pharmacy laws and guidelines
• Self-motivation and the ability to work effectively in an independent environment
• Provide quality customer service by being available for scheduled shifts. Includes arriving promptly and completing shifts as needed to meet demands of the department
• Excellent communication and organizational skills by practicing active listening and seeking to understand others
• Detail oriented
• Works to deliver an expected volume of work, seeks operating efficiencies without sacrificing quality
• Provides constructive feedback and is receptive to feedback from others
• Upholds professional and ethical standards. Demonstrates departmental and organizational values including integrity, compassion, accountability, respect, and excellence
• Keeps abreast of new developments and enhancements to systems, procedures, and products. Values learning and seeks out new learning and development opportunities
• Uses good judgment when evaluating problems and makes appropriate decisions in a timely manner
• Understands and adheres to departmental and organizational standards, policies, and processes as appropriate

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Prescription drug insurance
• Referral program
• Vision insurance
• Work from home

Work Location: Hybrid remote in Noblesville, IN 46060

Salary : $33,950 - $42,670