At our company, we move fast, adapt quickly, and turn challenges into opportunities-all while keeping quality at the heart of everything we do. We believe that work should be a positive and respectful place, and that with the right mindset, anything is achievable.
Our Vision:
Fulfill the essential promise of pharmacy care and help people to live to their healthiest, happiest, and fullest potential.
Our Mission:
To be the disruptive force that drives meaningful change within pharmacy services.
Essential Duties & 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.
- Assists 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.