Pharmacy Adjudication Technician

Pharmacy Solutions Group -

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