What are the responsibilities and job description for the Pharmacy Adjudication Technician position at CommuniCare Family of Companies?
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
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