What are the responsibilities and job description for the Pharmacy Adjudication Technician position at CommuniCare Health Services?
Pharmacy Solutions Group is currently recruiting an Adjudication Technician to join our Indiana team!
Responsibilities
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
