Adjudication Supervisor

MedWiz Solutions, LLC; New York (NY); On-site; USD 40,000 - 60,000; Full time

Job summary

MedWiz Solutions, LLC. is seeking a Supervisor, Adjudication to oversee daily prescription adjudication workflow, monitor productivity, and act as a technical resource for the team.

In this role, you will ensure timely processing, address billing issues, train staff, coordinate staffing, and partner with the Adjudication Manager to drive process improvements and department performance.

Qualifications

• 1–3 years data entry, pharmacy billing, adjudication, or related experience.
• Working knowledge of prescription adjudication, billing and pharmacy processes.
• Intermediate computer proficiency with pharmacy software.
• Ability to organize workflow and manage priorities.
• Strong communication and problem-solving skills.

Responsibilities

• Oversee daily adjudication workflow and address issues accurately and timely.
• Monitor productivity and priorities; partner with Adjudication Manager.
• Ensure billing cut-offs and deadlines are met for timely processing.
• Support new procedures and monitor consistent execution.
• Coordinate staffing coverage and adjust schedules as needed.
• Support payroll and timekeeping activities.
• Identify performance or conduct concerns and escalate as needed.
• Train technicians and maintain training materials.
• Serve as a technical/workflow resource for the team.
• Coordinate with other pharmacy/operational teams.
• Identify workflow improvements and propose solutions.
• Maintain documentation and consistent billing practices.

Skills

Communication

Problem solving

Attention to detail

Organizational skills

Education

High School Diploma or GED

Tools

EMAR

Pyxis MedBank

Frameworks

Job description

Description

The Supervisor, Adjudication supports the accurate and timely adjudication and billing of prescriptions by overseeing daily workflow, monitoring productivity, and serving as a technical resource to the adjudication team. The role helps ensure prescription rejections, payer changes, billing issues, and related work are completed accurately and on time. The Supervisor partners with the Adjudication Manager to support workflow execution, training, process consistency, and department performance.

Job Responsibilities

• Oversee daily adjudication workflow and help ensure prescription rejections and billing issues are addressed accurately and timely.
• Monitor workflow, productivity, and department priorities and partner with the Adjudication Manager to address gaps or changing business needs.
• Help ensure billing cut-offs and operational deadlines are met to support timely prescription processing and deliveries.
• Support implementation of new procedures, policies, and workflow changes and monitor consistent execution.
• Coordinate staffing coverage and recommend schedule adjustments based on workflow, business needs, and approved time off.
• Support payroll and timekeeping activities as assigned.
• Identify performance, attendance, workflow, or conduct concerns and elevate them to the Adjudication Manager for appropriate follow-up.
• Train and support technicians and help maintain current training materials, procedures, and job resources.
• Serve as a technical and workflow resource to team members and assist with resolution of more complex adjudication or billing issues.
• Support effective coordination between adjudication and other pharmacy or operational teams.
• Identify workflow and process improvement opportunities and recommend solutions to department leadership.
• Maintain accurate documentation and support consistent billing practices.
• Perform other activities assigned by leadership.

Requirements

Basic Qualifications

• High School Diploma or GED and 1–3 years of data entry, pharmacy billing, adjudication, or related experience, or an equivalent combination of education and experience.
• Working knowledge of prescription adjudication, billing, data entry, or related pharmacy processes.
• Intermediate computer proficiency and ability to use pharmacy and medication distribution software.
• Ability to organize and coordinate workflow, manage competing priorities, and support timely completion of department requirements.
• Strong communication, problem-solving, attention to detail, and organizational skills.
• Ability to read and interpret medication documentation, business correspondence, procedures, reports, and related information.
• Ability to perform basic mathematical calculations and understand rates, percentages, reports, charts, and operational data.

Preferred Qualifications

• Long-term care pharmacy experience.
• PTCB certification.
• Experience with pharmacy or medication distribution systems such as EMAR, Pyxis MedBank, Frameworks, or comparable systems.
• Experience training, guiding, or serving as a workflow resource to other team members.

Compensation: $40,000-$60,000