Remote LTC Pharmacy Adjudication Technician

Symbria•Woodridge, IL

3d•Remote

About The Position

Symbria Rx Services is hiring a remote LTC Pharmacy Adjudication Technician to support pharmacy adjudication, insurance billing, and account maintenance for senior-living and post-acute communities. The role communicates with communities when medication orders are non-formulary, expensive, or incomplete, and works with community staff to clarify orders or identify less expensive alternatives. It also coordinates Medicare Part D claim adjudication and helps maintain, update, and bill customer accounts accurately and on time. The schedule is 2:30 p.m.–11:00 p.m. CST, Monday through Friday, and every other weekend, with rotating holidays required. Applicants must currently reside in a state where Symbria Rx Services is licensed: Arizona, Colorado, Florida, Illinois, Indiana, Kansas, Massachusetts, Michigan, Missouri, Pennsylvania, Ohio, or Wisconsin. The role is 100% remote and requires the employee to provide high-speed cable or fiber internet access meeting specified speed and latency requirements. Symbria does not provide or reimburse internet service and may verify that the home system meets its requirements. Symbria is a 100% employee-owned healthcare provider serving geriatric patients in senior-living and post-acute settings. The company describes its work as patient-centered and guided by values including integrity, compassion, stewardship, innovation, and teamwork.

Requirements

High school diploma or GED.
Pharmacy Technician license and/or certification (CPhT) as required by state; must be licensed in Illinois and Massachusetts within 60 days of hire.
At least one year of data entry experience.
Excellent customer service, interpersonal, verbal, and written communication skills.
General computer knowledge, including Microsoft Word, Excel, and Outlook.
Ability to stay organized, multitask, and prioritize assignments and projects.
Strong knowledge of brand and generic drugs and medical terminology.
Must currently live in a state where Symbria Rx Services is licensed: AZ, CO, FL, IL, IN, KS, MA, MI, MO, PA, OH, or WI.
Must provide high-speed internet via cable or fiber; DSL and satellite service are not accepted. Connection requirements include latency below 35 and download/upload speeds dependent on the number of locally connected devices.
Must work 2:30 p.m.–11:00 p.m. CST Monday through Friday, every other weekend, and rotating holidays.

Nice To Haves

At least one year of prescription billing experience.

Responsibilities

Communicate with communities about expensive and non-formulary medication orders and educate them about less expensive alternatives identified by staff pharmacists.
Communicate with communities about incomplete orders that require clarification.
Maintain detailed records of orders requiring community communication for potential follow-up.
Follow up with communities according to policy timeframes when medications have not been changed or clarified, and send another medication supply if needed.
Communicate professionally with community management staff, including Directors of Nursing and Administrators, by phone or email.
Assist with order data entry as needed.
Assist with answering phone calls for the data entry department.
Review Medicare Part D rejections and prior authorizations, coordinating with pharmacists or physicians to adjudicate claims successfully.
Work with designated operations staff to prepare for formulary changes.
Perform insurance and billing clerical duties, including reviewing and maintaining patient account information.
Prepare and submit claims to third parties electronically or on paper.
Identify and resolve claim denials.
Serve as a liaison between patients and third parties.
Collaborate with team members and the supervisor to share best practices.
Provide backup support to other pharmacy departments based on business needs or production levels.
Perform other duties as assigned.