Claims Adjudication Coordinator

Responsibilities

• Accurately performs the billing and adjudication functions in Pioneer Rx.
• Reviews, applies, and rectifies assignment of benefits claims for proper billing sequence, methods, and application.
• Notifies Patient Care Coordinators of all exceptions and errors in a timely and productive manner.
• Responsible for all communication to ensure that action items that were not processed as planned by the Patient Care Coordinators (PCC’s) are complete (any insurance rejections, prior authorizations, problems with patient packet assembly, etc.).
• Checks cycle fill claims/patients for missing prescriptions and copay assistance options.
• Enters and charges credit cards when applicable.
• Accurately works all insurance rejections that are found with all processing of claims.
• Communicates to the PA team and Pharmacy team when any exceptions and errors that effect these departments are found and not resolved.
• Holds claims that require further clarification and/or follow up from appropriate staff.
• Performs daily Quality Check reporting to verify accuracy of the days processing of claims.
• Runs and reviews various assigned reports daily, corrects claims identified as missed or incorrect, and notifies the Patient Care Coordinators of any exceptions and errors that cannot be resolved.
• Applies for copay assistance for applicable drugs and price plans.
• Performs QA functions on all claims in Pioneer Rx daily/weekly/monthly.
• General administrative support as assigned by manager.
• Provides back up to team members as needed.

Qualifications

• Requires a high school diploma or equivalent.
• Minimum of 2 years experience as a Registered Pharmacy Technician in the state of GA.

Benefits

• Competitive pay
• Paid holidays
• Benefits
• Paid time off
• A work/life balance
• Paid parental leave
• Recognition programs
• Promotion opportunities
• A comprehensive training program to enhance your career
• Employee prescription discounts

Core Values

• Integrity
• Communication
• Accountability
• Relationships
• Excellence