What are the responsibilities and job description for the Adjudication/Reimbursement Specialist position at Absolute Companies?
Adjudication/Reimbursement Specialist
Position Overview:
The Adjudication/Reimbursement Specialist plays a critical role in the pharmacy billing process by ensuring that all patient and billing information is accurate, and prescriptions are properly billed to the correct payer source. This position requires strong attention to detail, excellent communication skills, and the ability to work both independently and collaboratively within a fast-paced team environment.
The Adjudication/Reimbursement Specialist plays a critical role in the pharmacy billing process by ensuring that all patient and billing information is accurate, and prescriptions are properly billed to the correct payer source. This position requires strong attention to detail, excellent communication skills, and the ability to work both independently and collaboratively within a fast-paced team environment.
Schedule:
- Flexible afternoon shifts
- Rotating weekends
Requirements:
- State registration required upon hire
- Pharmacy Technician Certification must be obtained within 1 year of hire
- Basic experience with Microsoft Word and Excel
- Excellent written and verbal communication skills
- Strong multitasking abilities
- Self-motivated and detail-oriented
- Able to work well independently and within a team
Primary Responsibilities:
- Verify insurance and patient information for accuracy
- Ensure prescriptions are billed in accordance with payer source guidelines, pricing, and billing regulations
- Respond to incoming calls from facilities, guarantors, and insurance companies
- Initiate and follow up on prior authorizations
- Review and address audits from insurance providers
- Reconcile online third-party claims
- Handle insurance and Medicaid rejections from remittances
- Perform other duties as assigned
Core Competencies:
- Accuracy and attention to detail
- Customer service and professionalism
- Strong organizational and time-management skills
- Initiative and reliability
- Team-focused mindset
Join our team of professionals dedicated to delivering high-quality service, maintaining operational excellence, and ensuring patient satisfaction through expert reimbursement and billing practices.
