Pharmacy Adjudication Technician

CommuniCare Family of Companies
Charleston, WV, United States
Full-time

Pharmacy Adjudication Technician

Pharmacy Solutions Group is currently recruiting an Adjudication Technician to join our West Virginia team!

Responsibilities :

  • Responsible for adjudication of daily unit dose and non-unit dose claims
  • Contacting insurance for proper overrides
  • New Admits for assigned homes (MOP, group codes, tax group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable)
  • Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.
  • Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable).
  • Welcome Packets - prepare Welcome Packet to all new PVT patients / families.
  • Receptionist will mail and Print the packet.
  • Ensure documents in ECM Billing folders are worked timely
  • Ensure Emails to Billing Email are worked timely
  • Authorizations - gaining approval from facilities and families on non-covered meds or medication requiring authorization
  • Manage Monthly Adjudication of Cycle Batches / Unit Dose Reject Batches
  • Working assigned Customer Notes in a timely manner
  • Adding Hospice and VA Med list
  • Cubex Temp patients for LTC
  • Work any BI-Call batches for homes
  • Assist billing with rebilling / working open billing batches
  • Communicate issues in preventing batches from being posted in a timely manner
  • Assist with other projects as assigned
  • 23 days ago
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