Adjudication Pharmacy Technician (Ohio)

Custom Health•North Canton, OH

About The Position

Finney's Institutional Pharmacy is seeking a motivated, customer-oriented Adjudication Pharmacy Technician to help ensure prescriptions are dispensed to eligible patients and billed correctly under their benefit plans. The role involves confirming eligibility, processing and resolving claims, supporting billing operations, and providing professional service to customers, colleagues, facilities, physicians, and payors. The position is part of a collaborative adjudication team and includes several hours of phone communication each day. The work is primarily Monday through Friday, 8:30 a.m. to 5:30 p.m., with additional time as required by daily workloads. It is a seated position that may involve extended sitting and regular use of a desktop keyboard and mouse. Participation in the on-call rotation is voluntary and includes incentive pay. Finney's parent owner, Custom Health, describes itself as providing technology-enabled medication management and managed care services across the United States and Canada.

Requirements

At least 1 year of billing experience.
Proficiency in Microsoft Word and Excel.
Ability to communicate courteously and professionally with employees, patients, caregivers, physicians, facilities, and payors by phone, fax, and email.
Ability to sit for extended periods and operate a desktop keyboard and mouse.

Nice To Haves

An active pharmacy technician license from the Ohio State Board of Pharmacy is preferred.
Previous pharmacy experience is highly valuable and desired.

Responsibilities

Perform billing duties as needed and handle pharmacy point-of-sale adjudication.
Contact payors and outside agencies to verify information and resolve common non-clinical problems.
Run weekly billing reports.
Obtain accurate billing and resident information; rebill and resolve unpaid claims through adjudication.
Rebill and reconcile incorrectly billed claims and non-clinical third-party denials.
Identify, process, and resolve denied claims in a timely manner.
Document communications concerning denied claims and resolutions communicated to facilities or physicians.
Obtain prior authorizations and non-covered forms.
Obtain Part B documentation.
Assist with online billing of DME supplies through Medicaid.
Resolve hospice denials and communicate denied claims to hospice nurses.
Follow current operating procedures and meet end-of-month processes and deadlines.
Use DocuTrack to locate documents and fax them to facilities or for audit purposes.
Handle customer requests promptly and professionally and resolve billing inquiries.
Communicate with third-party payors to resolve denied claims.
Complete and verify customer pricing requests and direct inquiries to the appropriate team or individual.
Maintain a positive demeanor and use problem-solving, interpersonal, patience, and telephone skills.
Document customer issues using the CPAS form and communicate them to management.
Work with Billing/Collection Managers on special projects as needed.
Perform other duties as assigned.