Claims Adjudication Specialist - Healthcare Billing

Curant Health; Smyrna (GA); Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Paid holidays

Paid time off

Parental leave

Employee prescription discounts

Job summary

Curant Health in Smyrna, GA is seeking a Claims Adjudication Coordinator to join our growing team. This role focuses on adjudication of prescription claims, handling primary, secondary, and tertiary insurance submissions, and ensuring accuracy in the billing process.

The ideal candidate is a GA-registered Pharmacy Technician with at least two years of experience, a detail-oriented mindset, and a commitment to delivering high-quality customer service.

Qualifications

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

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.
• Communication to the PA team and Pharmacy team when any exceptions and errors that affect these departments are found and not resolved.
• 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.
• 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 PCCs 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.

Skills

Pharmacy experience

Education

High school diploma or equivalent

GA Registered Pharmacy Technician

Job description

Curant Health in Smyrna, GA is seeking a Claims Adjudication Coordinator to join our growing team. This role focuses on adjudication of prescription claims, handling primary, secondary, and tertiary insurance submissions, and ensuring accuracy in the billing process.

The ideal candidate is a GA-registered Pharmacy Technician with at least two years of experience, a detail-oriented mindset, and a commitment to delivering high-quality customer service.