Claims Adjudication Coordinator

Curant Health Georgia LLC; Smyrna (GA); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Competitive pay

Paid holidays

Benefits

Paid time off

Work/life balance

Parental leave

Recognition programs

Promotion opportunities

Training program

Employee discounts

Job summary

Curant Health in Smyrna, GA is seeking a Claims Adjudication Coordinator to manage billing and adjudication of prescription claims across primary, secondary, and tertiary insurance levels. The role emphasizes accuracy, timely communication with PCCs, and compliance with SOPs.

The ideal candidate is a GA-registered Pharmacy Technician with at least 2 years of experience, ready to contribute to a fast-growing healthcare company and deliver quality patient service.

Qualifications

• Minimum of 2 years experience.
• Registered Pharmacy Technician in GA.
• High school diploma or equivalent.

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 PCCs are complete.
• 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.
• Communications to the PA and Pharmacy teams when exceptions and errors are found.
• Double checks secondary/tertiary claims for compliance and copay/financial assistance opportunities.
• Double checks 340b compliance to SOP, P&Ps, and SOWs.
• Provides follow-up on actions items needing approval from PCCs and Pharmacy staff.
• Holds claims requiring further clarification and follow up from appropriate staff.
• Performs daily quality check reporting and reviews reports to correct missed/incorrect claims.
• Applies for copay assistance for applicable drugs and price plans.
• Performs QA on all claims in Pioneer Rx daily/weekly/monthly.
• General administrative support and back-up to team members.

Education

Registered Pharmacy Technician GA

Job description

Georgia
200 Technology Ct SE
Suite B
Smyrna, GA 30082, USA

Description

JOIN A LEADING HEALTHCARE COMPANY

Do you dream of a great career with a great company – where you can make an impact and help people? We dream of giving you the opportunity to do just this.

We are not only committed to improving the lives of patients we serve, but yours as well. Curant means CARE, and that is just what we do.

Our culture of caring is evident by being recognized as one of Inc.’s fastest growing healthcare companies, receiving the Georgia Fast 40 and Atlanta Business Chronicle Trendsetters awards every year since 2013. Our medication management programs and processes are proven to improve outcomes while reducing overall healthcare costs for our patients.

Curant Curant Health is searching for a Claims Adjudication Coordinator to join its team in Smyrna, GA. This position is primarily responsible for all adjudication of prescription claims which includes primary, secondary and tertiary insurance claims.

Responsibilities

With your passion to help patients and your drive to make an impact on those you touch, you will lead a business unit to drive operational results and deliver world class customer service. Your experience, positive attitude and your drive to deliver results will help navigate the excitement of a fast-growing company and all the fun and excitement that comes with it. We have listed a few of your responsibilities below:

• 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.
• Communication to the PA team and Pharmacy team when any exceptions and errors that effect these departments are found and not resolved.
• Double checks accuracy of secondary and tertiary claims to ensure compliance to department policies and seeks copay and financial assistance for claims that qualify.
• Double checks 340b compliance to SOP, P&P’s, and SOW’s.
• Provides communication and follow-up on actions items that need approval from the Patient Care Coordinators and Pharmacy staff.
• Holds claims that require further clarification and/or follow up from appropriate staff. 30
• 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. Provide back up to team members as needed.

Qualifications

Requires a high school diploma or equivalent with a

Minimum of 2 years experience

Registered Pharmacy Technician in the state of GA

Why Work for Us?

• 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

Our Core Values consist of ICARE; Integrity, Communication, Accountability, Relationships and Excellence, and we take pride in you embodying those traits. Curant Health is an equal opportunity employer.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.