Claims Adjudicator - Full-time

pbr/p pspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt; font-weight: bold"Job Summary/span/p pspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"The Claims Adjudicator facilitates the claims adjudication process through effective claims/spanbrspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"management. The incumbent will ensure claim accuracy, bill payors, and coordinate with the Copay Assistance Department as necessary./span/p pbrspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt; font-weight: bold"Duties and Responsibilities/spanbr/p ul lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Claims analysis (cost of goods, total allowed amount, portion paid by the insurance, patient’s copay)/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Test claim refill orders/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Troubleshoot claim rejections/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Bill primary and secondary payors/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Review coverage of primary and secondary payors/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Coordinate with Copay Assistance Department when copay funds are depleted to obtain additional funds/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Coordinate with the Patient Care Coordinator Supervisor the order claim status if there is a delay in scheduling/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Identify and add new payors when the patient’s insurance has changed/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Ensure accuracy of NCPDP claim submission/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Review order profitability/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Proper documentation of patient’s medication coverage in progress notes/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Ensure compliance with the 14-day window of adjudication and scheduled delivery/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Manage claims exception/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Reports underpaid claims, changes in reimbursement from previous claims, pricing issues, and billing or copay assistance issues to supervisor/span/li /ul pbr/p pspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt; font-weight: bold"Required Qualifications/span/p ul lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Well-organized and strong attention to detail/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"NCPDP Claim Submission Experience/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"High School diploma or equivalency/span/li /ul pbr/p pspan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt; font-weight: bold"span style="font-weight: bold"Preferred Qualifications/span/span/p ul lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"Prior authorization/override experience preferred/span/li lispan style="font-family: tahoma, arial, helvetica, sans-serif; font-size: 10pt"CPR+ experience preferred/span/li /ul pbr/p