Adjudication Pharmacy Technician

Innovative Rx Us Holdings, Inc.; North Canton (OH); On-site; USD 35,000 - 50,000; Full time

Benefits offered by this job

14 Days of PTO in the first year

Multiple Healthcare Plans

401(k) Retirement Plan with a generous company match

Job summary

Finney's Institutional Pharmacy is looking for an Adjudication Pharmacy Technician based in Ohio. You will be a key part of the adjudication team, managing the billing of prescriptions and ensuring proper eligibility verification. This role demands excellent customer service and effective communication.

Requirements include an active pharmacy technician license, previous pharmacy experience, and proficiency in billing procedures. The position offers a full-time schedule with various benefits including PTO and healthcare plans.

Qualifications

• Active pharmacy technician license preferred.
• At least 1 year of billing experience is required.
• Previous pharmacy experience is highly valued.

Responsibilities

• Perform Billing duties as needed.
• Contact payors to verify information and resolve problems.
• Run weekly billing reports.
• Communicate effectively with customers and third-party payors.

Skills

Billing experience

Microsoft Word

Microsoft Excel

Education

Active pharmacy technician license from the Ohio State Board of Pharmacy

Previous pharmacy experience

Job description

Job Title: Adjudication Pharmacy Technician

Company: Finney's Institutional Pharmacy

Location: Indianapolis, IN OR North Canton, OH

Job Type: Full-time

Job Description

Finney's Institutional Pharmacy is seeking a motivated and customer‑oriented individual to join our team as an Adjudication Pharmacy Technician. As a vital part of our adjudication team, you will be responsible for ensuring prescriptions are dispensed to eligible patients and billed properly in accordance with their benefit plan. Additionally, you will maintain a positive and pleasant demeanor with all customers and colleagues while accurately confirming eligibility and billing.

Responsibilities

• Perform Billing duties as needed
• Understand the pharmacy front‑end process and perform point of sale functions (adjudication)
• Contact payors and/or other outside agencies to verify information and resolve common, non‑clinical problems
• Run weekly billing reports
• Obtain accurate billing and resident information, and rebill and resolve unpaid claims through adjudication
• Re‑bill and reconcile all incorrectly billed, non‑clinical third‑party denials
• Identify and resolve and process denied claims in a timely manner
• Document all communication concerning denied claims and any resolution communicated to facility or physicians
• Obtain Prior Authorizations and non‑covered forms
• Obtain Part B documentation
• Assist with billing DME supplies on line (Medicaid)
• Resolve Hospice denials and communicate to Hospice nurses any denied claims
• Adhere to and demonstrate mastery of current operating procedures
• Use DocuTrack skills to locate specific documents and fax documents to facilities and/or for audit purposes
• Stay in line with End of Month processes and deadlines
• Ensure customer requests are handled quickly and professionally
• Communicate effectively with customers to resolve billing inquiries
• Communicate effectively with third party payors to resolve denied claims
• Complete and verify pricing requests for customers
• Direct specific inquiries to the appropriate team / individual
• Maintain a positive, pleasant demeanor with all customers
• Utilize robust problem‑solving and people skills, patience, and telephone etiquette
• Document customer issues using CPAS form and communicate to management
• Work with Billing/Collection Managers on special projects as needed
• Other duties as assigned

Qualifications

• Active pharmacy technician license from the Ohio State Board of Pharmacy preferred
• Previous pharmacy experience extremely valuable and desired
• At least 1 year of billing experience
• Proficient in Microsoft Word and Excel

Working Conditions

• Normal working hours: Monday through Friday, 8:30AM to 5:30PM, with additional time as required based on daily workloads.
• This position may also include sitting for long periods of time.
• Participation in the on‑call rotation is voluntary, with incentive pay provided.
• Adjudication team members must work well together as a team.
• This position involves multiple hours of phone time per day speaking with Finney's doctors, leaders, administrators, and patients.

Physical Requirements

• This position requires sitting for extended periods of time.
• Operating a desktop keyboard and mouse.
• Communicating with employees, patients, caregivers, and physicians by phone, fax, and email in a courteous and professional manner.

Benefits

• (Primarily) Monday - Friday Day Shift
• Closed for 6 Paid Holidays
• 14 Days of PTO in the first year
• Multiple Healthcare Plans
• Dental and Vision Coverage
• Free Life Insurance
• Supplemental Insurance Plans
• 401(k) Retirement Plan with a generous company match
• Simple IRA
• Medical and Dependent Care Flex Spending Accounts
• $150 Initial Scrub Allowance, $50/year Continued Allowance

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.