Responsibilities
- Manages the adjudication inboxes
- Assists with medical claims billing
- Responsible for troubleshooting orders with a rejected status; refill too soon, increase/decrease of dose, duplicate claim, and eligibility issues.
- Responsible for the reconciliation of the master claims queue
- Assist with billing projects, ie. Member AR report, COGS, etc.
- Ensures insurance information is accurate for correct adjudication.
- Assist patients in the re‑enrollment of copay cards and patient assistance plans
- Communicates with patient assistance plans when necessary to obtain payment
- Assists with the timely initiation and resolution of prior authorizations
- Works with appropriate staff members to resolve claims issues
- Follow and aid in enforcement of all company policies and procedures.
- Respect and maintain confidentiality guidelines of HIPAA.
- Responsible for other duties as assigned.
Education and Experience
- High School Diploma or equivalent
- Certified and Registered Pharmacy Technician, (Colorado) in good standing required
- Registered with the State of Florida (Florida techs only) in good standing required, certification preferred
- Previous Prior Authorization or Claims experience is preferred
Knowledge, Skills, and Abilities
- Demonstrates a high degree of personal responsibility regarding accuracy and quality of work.
- Demonstrates ability to work effectively and maintain expected productivity.
- Ensures accuracy of information being provided to Management for review.
- Schedules own time based on priorities.
- Demonstrates Excellent customer service and Professionalism
- Ability to multi-task
- Ability to communicate effectively, patiently, and courteously.
- Ability to work in a high pace, stressful environment.
- Should be independent and self‑motivated.
- Maintains a good attendance record.
Work Environment / Physical Demands
This position is in a typical office environment which requires prolonged sitting and standing in front of a computer. In addition, this position requires hand‑eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients and employees. This position may be required to work long hours.
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