Adjudication Pharmacy Technician

Job Description

Young at Heart Pharmacy is seeking a motivated and customer-oriented individual to join our team as an Adjudication Pharmacy Technician. As a vital part of our adjudication team, you will be responsible for ensuring prescriptions are dispensed to eligible patients and billed properly in accordance with their benefit plan. Additionally, you will maintain a positive and pleasant demeanor with all customers and colleagues while accurately confirming eligibility and billing.

Parent Organization

Custom Health is a fully integrated Health-Tech company focused on delivering patient-centric health care as a service. We are on a mission to transform the patient experience for home-based patients, driving better patient outcomes and total cost of care reduction. Powered by our modern purpose-built technology platform, fully owned high-volume central fill pharmacy hubs, and a comprehensive in-house clinical care team, Custom Health delivers optimized and personalized care for home-based patients with precision and at scale.

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
• 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
• 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
• Other duties as assigned

Working Conditions

• Normal working hours: Monday through Friday, 9:00 AM to 6:30 PM, with additional time as required based on daily workloads.
• This position may also include sitting for long periods of time
• Participation in the on-call rotation is voluntary, with incentive pay provided.
• Adjudication team members must work well together as a team.
• This position involves multiple hours of phone time per day speaking with Young at Heart doctors, leaders, administrators, and patients.

Physical Requirements

• 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
• 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.

EEOC Statement

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.

Requirements

Qualifications Required

• Active tech-in-training permit from the Indiana State Board of Pharmacy by Day 1 of employment, in lieu of pharmacy technician license
• At least 1 year of billing experience
• Proficient in Microsoft word and Excel

Qualifications Preferred

• Pharmacy technician license from the Indiana State Board of Pharmacy preferred
• Experience in pharmacy industry