ProCare LTC Pharmacy understands the universal needs of healthcare institutions with a personal touch that only an independent pharmacy can offer. With years of experience we have the understanding and knowledge to move into the next generation of pharmacy services. ProCare LTC Pharmacy is seeking an Adjudication Representative to work remotely.

Salary: Commensurate with experience.

Schedule: 2nd shift hours 5pm-1:30am, 6pm-2:30am 4pm-12:30am or overnight 9pm-6am

Benefits include: (Wait Period Required)

• 401(k) with company match
• Dental Insurance
• Health Insurance
• Vision
• Paid Time off

Job Summary:

The adjudication representative is responsible for working prescription rejections to ensure patients receive their medications without delay while limiting the amount of liability for our customers and the pharmacy due to non-covered Rx’s.

Responsibilities:

• Working refill too soon rejections appropriately
• Creating detailed, accurate forms for non-covered medications
• Communicating forms to the appropriate recipients (internal and external)
• Triaging documents correctly in the document server
• Handling and replying to customer and pharmacy requests via communication methods
• Escalating issues to supervisors/leads and management if intervention is required
• Proper notation on prescriptions in the document server as well as in the billing comment sections of prescriptions
• Working rejections to the farthest possible outcome before triaging issue to other billing teams
• Post all hard copy payments to the Frameworks system.
• Process telephone payment requests.
• Satisfy payor in Frameworks or wherever payment matches expected reimbursement amount.
• Monitor reports for payment variances.
• Attend required meetings
• Assist in training of new and established employees

Qualifications

• High School Diploma/G.E.D.
• Computerized billing knowledge.
• Intermediate level computer skills required, including Excel and Word.
• Typing 25 words per minute.
• Clerical experience relating to insurance verification in a long term care pharmacy or suitable combination of education and experience preferred .
• Familiarity with third party insurer regulations and long-term care pharmacy
• 1 year: Medical billing procedures.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. This is not a complete list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.