Adjudication Pharmacy Technician (Ohio)

Description

Job Description:

Finney's Institutional Pharmacy is seeking a motivated and customer-oriented individual to join our team as an Adjudication Pharmacy Technician. As a vital part of our adjudication team, you will be responsible for ensuring prescriptions are dispensed to eligible patients and billed properly in accordance with their benefit plan. Additionally, you will maintain a positive and pleasant demeanor with all customers and colleagues while accurately confirming eligibility and billing.

Parent Owner:

Custom Health provides a comprehensive tech-enabled med management and managed care solution resulting in 98% medication adherence for our patients across the United States and Canada. Operations are powered by proprietary software which orchestrates fully automated owned and network pharmacies, at-home medication management solutions, real-time clinical oversight by 200+ pharmacist-lead clinicians and the collection of real-time, real-world data and insights.

Responsibilities:

• Perform billing duties as needed.
• Understand the pharmacy front-end process and perform point of sale functions (adjudication).
• Contact payors and/or other outside agencies to verify information and resolve common, non-clinical problems.
• Run weekly billing reports.
• Obtain accurate billing and resident information and rebill and resolve unpaid claims through adjudication.
• Re-bill and reconcile all incorrectly billed, non-clinical third-party denials.
• Identify and resolve and process denied claims in a timely manner.
• Document all communication concerning denied claims and any resolution communicated to facility or physicians.
• Obtain prior Authorizations and non-covered forms.
• Obtain Part B documentation.
• Assist with billing DME supplies on-line (Medicaid).
• Resolve hospice denials and communicate to Hospice nurses any denied claims.
• Adhere to and demonstrate mastery of current operating procedures.
• Use DocuTrack skills to locate specific documents and fax documents to facilities and/or for audit purposes.
• Stay in line with End of Month processes and deadlines.
• Ensure customer requests are handled quickly and professionally.
• Communicate effectively with customers to resolve billing inquiries.
• Communicate effectively with third party payors to resolve denied claims.
• Complete and verify pricing requests for customers.
• Direct specific inquiries to the appropriate team / individual.
• Maintain a positive, pleasant demeanor with all customers.
• Utilize robust problem-solving and people skills, patience, and telephone etiquette.
• Document customer issues using CPAS form and communicate to management.
• Work with Billing/Collection Managers on special projects as needed.
• Other duties as assigned.

Working Conditions:

• Normal working hours: Monday through Friday, 8:30AM to 5:30PM, with additional time as required based on daily workloads.
• This position may also include sitting for long periods of time.
• Participation in the on-call rotation is voluntary, with incentive pay provided.
• Adjudication team members must work well together as a team.
• This position involves multiple hours of phone time per day speaking with Finney's doctors, leaders, administrators, and patients.

Physical Requirements:

• This position requires sitting for extended periods of time.
• Operating a desktop keyboard and mouse.
• Communicating with employees, patients, caregivers, and physicians by phone, fax, and email in a courteous and professional manner.

Why Pharmacy Technicians Love Working Here:

• Work-Life Balance: Monday through Friday day shift, 8:30AM to 5:30PM.
• Great Environment: This is a seated position—heavy standing/lifting is not required.
• Generous Time Off: 14 days of PTO in your first year + 6 paid holidays (Closed on major holidays!).
• Excellent Benefits: Multiple healthcare plans, Dental/Vision, Free Life Insurance, 401(k) with generous company match, and a $150 initial scrub allowance.

WE PROUDLY OFFER:

• (Primarily) Monday - Friday Day Shift
• Closed for 6 Paid Holidays
• 14 Days of PTO in the first year
• Multiple Healthcare Plans
• Dental and Vision Coverage
• Free Life Insurance
• Supplemental Insurance Plans
• 401(k) Retirement Plan with a generous company match
• Simple IRA
• Medical and Dependent Care Flex Spending Accounts
• $150 Initial Scrub Allowance, $50/year Continued Allowance

Join us at Finney's Institutional Pharmacy and become a valuable member of our dedicated team committed to providing exceptional customer service in the healthcare industry.

EEOC Statement

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Requirements

Qualifications:

• Active pharmacy technician license from the Ohio State Board of Pharmacy preferred.
• Previous pharmacy experience extremely valuable and desired.
• At least 1 year of billing experience.
• Proficient in Microsoft word and Excel.