Pharmacy Adjudication Technician - Pharmacy Solutions Group

Pharmacy Adjudication Technician

Pharmacy Solutions Group is currently recruiting an Adjudication Technician to join our Ohio team!
Responsibilities: 

* Responsible for adjudication of daily unit dose and non-unit dose claims

• Contacting insurance for proper overrides 

* New Admits for assigned homes (MOP, group codes, tax group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable) 

• Contacting families on new admits ensuring we have the proper method of payment established when no insurance found or address issues.    
• Running New Admit Report on a weekly basis auditing admits for (MOP, group codes, tax Group, addresses, invoice group, customer group, allergies, MRN, MEDA Days, Per Diem Days when applicable) 
• Welcome Packets – prepare Welcome Packet to all new PVT patients/families
• Receptionist will mail and Print the packet

* Ensure documents in ECM Billing folders are worked timely

* Ensure Emails to Billing Email are worked timely 

* Authorizations – gaining approval from facilities and families on non-covered meds or medication requiring authorization

* Manage Monthly Adjudication of Cycle Batches/ Unit Dose Reject Batches

* Working assigned Customer Notes in a timely manner

* Adding Hospice and VA Med list 

* Cubex Temp patients for LTC 

* Work any BI-Call batches for homes

* Assist billing with rebilling/working open billing batches

• Communicate issues in preventing batches from being posted in a timely manner

* Assist with other projects as assigned