Pharmacy Adjudicator

Be a Pharmacy Adjudicator—review and process pharmacy claims, resolve rejections, and support timely medication delivery. Must have a BS Pharmacy background, strong analytical skills, and knowledge of pharmacology or medical claims.

Job Description

The Pharmacy Adjudicator position will adjudicate pharmacy claims, review claims responses for accuracy. Ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtains overrides if appropriate and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claims rejections.

Responsibilities

Performed duties assigned by an Adjudication Supervisor. Process Medicare, Medicaid, Hospice and Insurance claims for payment.
Interpret claims rejections and Refill Too Soon outcomes.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.
Adjudicates pharmacy claims for prescription in active workflow for primary, secondary and tertiary pharmacy plans and reviews claims responses for accuracy before accepting the claim.

Minimum Qualifications

Must be a graduate or undergraduate of BS Pharmacy
Should have appropriate knowledge and understanding of Adjudication role in Claims/Billing industry, including quality improvement processes that may be used to monitor billing ability to fulfill its responsibilities within a given health care system.
Strong organizational and analytical skills required.
Must be able to actively contribute to a positive team environment.
Must be self-starter with the ability to handle multiple tasks, remain focused and work independently.
Must be detail oriented and able to thrive in a fast-paced environment.
Knowledge in Pharmacology and/or medical claims terminology
Accurate Typing Skills
Proficient computer skills in Excel, Word and other basic programs.
Strong ability to work independently

Date Posted:

4 days ago

Location:

SJDM, Bulacan

Title:

Pharmacy Adjudicator

Job Type:

Full-time

Category:

Non-Clinical

Account:

Voice and non-voice accounts

Shift:

Night Shift, Shifting Schedule

Experience Level:

At least 1 year of Pharmacy Assistant experience

ACS Pro Global is the top solutions provider in Bulacan, Philippines, serving US-based clients in the healthcare industry. Offering clinical and non-clinical services, we empower businesses to boost productivity and patient experience while providing our employees with global career opportunities.

Pharmacy Adjudicator

Job Description

Responsibilities

Minimum Qualifications

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