Pharmacy Billing & Adjudication Specialist

Kph-Healthcare-Services; Town of Gouverneur (NY); Presencial; USD 36.000 - 60.000; Jornada completa

Descripción de la vacante

Paycom seeks a detail-oriented Pharmacy Adjudication and Billing Specialist to manage claim adjudication queues and communications with members and prescribers. The role supports prior authorizations through PA portals and ensures timely resolution of rejections or overrides.

The candidate will provide service coverage, contribute to training, and maintain productivity while complying with regulatory requirements and company standards.

Formación

• Broad knowledge of medications, physician orders and pharmacy systems.
• Familiar with Enterprise billing options and claim submission practices.
• Strong communication and outstanding customer service skills.
• Excellent organization and multitasking abilities.
• Proficiency with computers and keyboarding.

Responsabilidades

• Monitor adjudication queues and resolve issues.
• Contact members and prescribers on non-covered items.
• Facilitate prior authorization through designated portals.
• Provide professional communication to contracted clients.
• Handle outbound calls and direct inbound inquiries.
• Maintain production levels as directed by supervisor.
• Assist in training new employees.
• Complete mandatory regulatory training and related duties.

Conocimientos

Pharmacy knowledge

Billing systems

Customer service

Communication skills

Multitasking

Organization

Computer skills

Educación

High school diploma or GED

Pharmacy technician certification

Descripción del empleo

Paycom seeks a detail-oriented Pharmacy Adjudication and Billing Specialist to manage claim adjudication queues and communications with members and prescribers. The role supports prior authorizations through PA portals and ensures timely resolution of rejections or overrides.

The candidate will provide service coverage, contribute to training, and maintain productivity while complying with regulatory requirements and company standards.