Adjudication Pharmacy Technician

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 properly according to their benefit plans. The position also involves customer service, eligibility confirmation, claims resolution, billing support, and collaboration with customers, colleagues, payors, facilities, and physicians. The role is located in Indianapolis, Indiana, or North Canton, Ohio, and is full-time. The position follows normal Monday-through-Friday hours of 8:30 a.m. to 5:30 p.m., with additional time as required by workload. It is primarily a seated position and involves several hours of phone work per day. Participation in the on-call rotation is voluntary and includes incentive pay.

Requirements

At least 1 year of billing experience.
Proficient in Microsoft Word and Excel.
Ability to work well as part of a team.
Ability to communicate professionally by phone, fax, and email with customers and colleagues.

Nice To Haves

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

Responsibilities

Perform billing duties as needed.
Understand the pharmacy front-end process and perform point-of-sale adjudication functions.
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, non-clinical third-party denials.
Identify, resolve, and process 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 for Medicaid.
Resolve hospice denials and communicate denied claims to hospice nurses.
Follow and demonstrate mastery of current operating procedures.
Use DocuTrack to locate documents and fax them to facilities or for audit purposes.
Meet end-of-month processes and deadlines.
Handle customer requests quickly and professionally and resolve billing inquiries.
Communicate with third-party payors to resolve denied claims.
Complete and verify customer pricing requests.
Direct specific inquiries to the appropriate team or individual.
Maintain a positive, pleasant demeanor with customers.
Use problem-solving and people skills, patience, and telephone etiquette.
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.