Pharmacy Adjudication Technician

Presbyterian Homes & Services•Saint Paul, MN

10d•$23 - $26•Onsite

About The Position

Presbyterian Homes & Services is seeking a Pharmacy Adjudication Technician to join its Radius Living Rx team. The Pharmacy Adjudication Technician supports accurate and timely reimbursement for medications and services provided to long-term care facilities and their residents. This position reviews, analyzes, and processes insurance claims; resolves discrepancies, rejections, and denials; and works with insurance companies, healthcare providers, facilities, and internal teams so that billing issues do not delay medication delivery to residents. The Pharmacy Adjudication Technician reports to the Billing Manager. Radius Living Rx is a long-term care pharmacy serving residents in partner communities across Minnesota and Wisconsin. Our pharmacists, technicians, and support staff work closely with facility care teams and prescribers, so the work stays close to the people it's for. We're building a team that wants pharmacy practice grounded in that relationship: careful medication management, direct communication with facility staff, and a genuine stake in how residents are doing.

Requirements

High school diploma or equivalent.
Prior experience in pharmacy or medical claims adjudication.
Excellent verbal and written communication skills, strong listening skills, and strong interpersonal skills to work effectively with other healthcare professionals.
Demonstrated ability to work with a high degree of accuracy and attention to detail and to handle multiple tasks simultaneously, prioritizing appropriately.
Desire and willingness to learn and perform new tasks.
Self-motivation and self-direction.
Demonstrated compatibility with PHS's mission and operating philosophies.
Demonstrated ability to read, write, speak, and understand the English language to communicate with all customers.

Nice To Haves

Active Minnesota Pharmacy Technician registration.
Prior experience in long-term care (LTC) pharmacy.
Prior experience with FrameworkLTC.

Responsibilities

Review, analyze, and process insurance claims for medications and services provided to long-term care facilities and their residents.
Address and resolve discrepancies, rejections, or denials of claims. Work with insurance companies, healthcare providers, and internal teams to ensure timely and accurate payments.
Maintain accurate records of claims processing, denials, adjustments, and correspondence with insurance carriers, facilities, and patients.
Ensure that all insurance adjudication processes comply with state and federal regulations, as well as pharmacy policies.
Communicate with insurance companies, other pharmacy teams, and healthcare professionals to resolve issues related to claims, billing, and reimbursement. Address any lingering issues that may be holding up medication delivery to residents, and provide timely updates and transparent communication to facilities and residents about delays or required actions.
Provide cross-functional support to other billing operations, including claims processing, prior authorizations, billing functions, and other administrative or revenue cycle responsibilities as workload demands.
Assist with special projects, process improvements, system enhancements, and other duties assigned by the Billing Manager.
Provide support to healthcare providers, pharmacies, and patients regarding insurance coverage, claims status, and payment issues.