Adjudication Technician

EmpowerMe Wellness • Maryland Heights, MO

3d

About The Position

A tech-enabled, multidisciplinary healthcare organization, EmpowerMe Wellness is on a mission to improve the lives of seniors. EmpowerMe enriches senior living communities nationwide through our fully integrated healthcare model, which features on-site care coordination, therapy, and pharmacy services. Headquartered in St. Louis, Missouri, our 3,500+ team members drive positive outcomes and build healthier, happier tomorrows for older adults. To learn more, visit empowerme.com today. The Adjudication Technician is responsible for accurately processing prescription claims and ensuring successful adjudication through pharmacy benefit managers (PBMs) and insurance providers. This role involves troubleshooting rejected claims, verifying patient and insurance information, and working closely with pharmacists, prescribers, and insurance companies to resolve issues quickly and efficiently.

Requirements

• High school diploma or equivalent
• Exemplary attention to detail
• Strong time management and organizational skills with ability to prioritize tasks as needed
• Well-received/respected by coworkers with willingness to maintain positive morale
• Excellent verbal and written communication skills
• Strong problem-solving and critical thinking abilities
• Ability to retain information such as words, numbers, and procedures
• Teamwork mindset with strong interpersonal skills
• Proficiency in Internet browsers (e.g. Explorer, Chrome, Fire Fox)
• Advanced knowledge of Microsoft Office programs: Outlook, Excel, Word and Publisher applications

Nice To Haves

• 1+ year Pharmacy Tech experience (preferred)
• Pharmacy Technician License (preferred)
• Experience in working with various EMR and medical billing systems would be a plus.

Responsibilities

• Process and resolve third-party insurance claims and rejections.
• Verify patient insurance information and ensure accurate claim adjudication.
• Initiate and follow-up on prior authorizations with prescribers’ offices.
• Communicate with PBMs, insurers, and healthcare providers to resolve issues.
• Maintain compliance with HIPAA, billing regulations, and documentation standards.
• Assist with audits and support general pharmacy operations as needed.
• Perform other duties as assigned that are consistent with qualifications, professional practices, and ethical standards
• Tasks and responsibilities are subject to change at your supervisor’s discretion
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED