Pharmacy Claims Adjudication Specialist

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

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.