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Cabin Creek

    Pharmacy Adjudication Technician - Cabin Creek, United States - CommuniCare Advantage

    CommuniCare Advantage
    CommuniCare Advantage Cabin Creek, United States

    3 weeks ago

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    Description
    Pharmacy Adjudication Technician

    Pharmacy Solutions Group is currently recruiting an Adjudication Technician to join our West Virginia 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
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