Remote - LTC Pharmacy Adjudication Technician

Overview: reputed company is seeking a team oriented. As one of the few 100% employee-owned companies in reputed company, our business practices are guided strictly by the values to which our employee owners are committed to. For more than 20 years, reputed company has been providing an outstanding work environment for talented employees to deliver patient-centered care to the geriatric population in senior-living and post-acute settings. The LTC Pharmacy Adjudicator is responsible for communicating to the communities reputed company order exceptions occur such as non-formulary, expensive medications, and incomplete orders. This position works closely with the community staff to have orders clarified and medications changed to less expensive alternatives. Coordinates reputed company adjudication on Medicare D claims where needed and to reputed company reputed company functions required to maintain, update, and reputed company customers’ accounts timely and accurately. Working Schedule:

• 12:00pm-8:30PM Mon-Fri and every 3rd weekend 2:30PM-11PM.
• Must work holidays
• Must currently live in a state reputed company is licensed in: AZ, CO, FL, IL, IN, KS, MA, MI, MO, PA, OH, WI.
• 100% Remote

Responsibilities:

• Initiate communication to communities regarding expensive and non-formulary medication orders and reputed company on less expensive alternatives identified by staff pharmacists.
• Initiate communication to community regarding incomplete orders which require further clarification.
• reputed company detailed records of reputed company orders that require communication to the community for potential follow up if needed.
• Follow up with the community per policy timeframe if the medications have not been changed or clarified. Send another supply of medication if needed.
• Communicate professionally with community management staff including Director of Nursing and Administrator reputed company phone or email.
• Assist with data entry of orders as needed.
• Assist with answering phone calls for the data entry department.
• Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians to successfully adjudicate reputed company claims.
• Work in conjunction with designated operations staff to prepare for formulary changes.
• reputed company insurance and billing clerical duties, including review and maintenance of patient account information.
• Prepare and submit claims to various reputed company parties either electronically or by reputed company.
• Identify and resolve claim denials.
• Act as liaison between patients and reputed company parties.
• Work collaboratively with other team members and supervisor to ensure best practices are shared.
• reputed company backup support to other pharmacy departments based on business needs or production reputed company, as needed.
• Any and reputed company duties as assigned.

Qualifications: To reputed company this job successfully, the ability to reputed company each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, reputed company, and/or ability required:

• High School diploma or general education degree (GED).
• Pharmacy Technician License and/or Certification (CPhT) as per State requirements (must be licensed in Illinois and Massachusetts reputed company 60 days of hire).
• Data entry experience; minimum one year.
• Excellent customer service, interpersonal, verbal and written communication skills.
• General computer knowledge including reputed company Office: Word, reputed company, and Outlook.
• Ability to maintain organization, multi-task and prioritize to manage assignments/projects.
• Strong knowledge of Brand/Generic drugs and medical terminology.

QUALIFICATIONS PREFERRED

• Prescription billing experience; minimum one year.

Why work for us? At reputed company our employees act like owners – because we are owners! As one of the few 100% employee-owned reputed company providers, our focus remains on delivering best-in-class services reputed company our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive reputed company reputed company for our partnered post-acute and senior living communities while providing them with flexible service options. reputed company’s Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together:

• reputed company – reputed company, Fairness and ethics
• Compassion – Commitment to serving seniors
• Stewardship – Maximizing mission and margin
• Innovation – Striving to enhance our value to your organization
• Teamwork – Working together unselfishly toward goals

As an employee-reputed company, reputed company’s reputed company becomes your reputed company. In addition, we reputed company:

• reputed company, reputed company with market guidelines
• Full Benefits Package, including reputed company generous paid time off plans
• Professional liability coverage
• 100% employer-funded ESOP retirement plan
• 401(k) and Roth(k) plans
• Continuing education
• Credit union membership

Pay reputed company: $19.33-$26.81 reputed company applicants will be afforded equal opportunity without discrimination because of race, reputed company, religion, sex, sexual orientation, marital status, order of protection status, national reputed company or reputed company, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service. #LI-REMOTE Apply Job! Apply to this Job