Claims Adjudication Coordinator

Curant Health•Smyrna, GA

4d•Onsite

About The Position

Curant Health is searching for a Claims Adjudication Coordinator to join its team in Smyrna, GA. This position is primarily responsible for all adjudication of prescription claims which includes primary, secondary and tertiary insurance claims. With your passion to help patients and your drive to make an impact on those you touch, you will lead a business unit to drive operational results and deliver world class customer service. Your experience, positive attitude and your drive to deliver results will help navigate the excitement of a fast-growing company and all the fun and excitement that comes with it.

Requirements

Requires a high school diploma or equivalent
Minimum of 2 years experience
Registered Pharmacy Technician in the state of GA

Responsibilities

Accurately performs the billing and adjudication functions in Pioneer Rx.
Reviews, applies, and rectifies assignment of benefits claims for proper billing sequence, methods, and application.
Notifies Patient Care Coordinators of all exceptions and errors in a timely and productive manner.
Responsible for all communication to ensure that action items that were not processed as planned by the Patient Care Coordinators (PCC’s) are complete (any insurance rejections, prior authorizations, problems with patient packet assembly, etc.).
Checks cycle fill claims/patients for missing prescriptions and copay assistance options.
Enters and charges credit cards when applicable
Accurately works all insurance rejections that are found with all processing of claims.
Communication to the PA team and Pharmacy team when any exceptions and errors that effect these departments are found and not resolved.
Double checks accuracy of secondary and tertiary claims to ensure compliance to department policies and seeks copay and financial assistance for claims that qualify.
Double checks 340b compliance to SOP, P&P’s, and SOW’s.
Provides communication and follow-up on actions items that need approval from the Patient Care Coordinators and Pharmacy staff.
Holds claims that require further clarification and/or follow up from appropriate staff.
Performs daily Quality Check reporting to verify accuracy of the days processing of claims.
Runs and reviews various assigned reports daily, corrects claims identified as missed or incorrect, and notifies the Patient Care Coordinators of any exceptions and errors that cannot be resolved.
Applies for copay assistance for applicable drugs and price plans.
Performs QA functions on all claims in Pioneer Rx daily/weekly/monthly
General administrative support as assigned by manager.
Provide back up to team members as needed.