Job Description for Full-Time Adjudicator - Sarasota, FL PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is the second largest institutional pharmacy company in America.PharMerica operates more than 100 institutional pharmacies in over 40 states and serves nursing facilities that care for approximately 350,000 patients. PharMerica Sarasota is recruiting for a Full-Time Adjudicator to join our team, working nights and weekends. Successful candidate will provide prompt and courteous service to customers ensuring timely provision of medications to customers and reimbursement to PharMerica. Essential Functions: • Works with Payers and other outside agencies to verifies information to ensure accurate processing and resolve potential clinical and non-clinical issues related to patient medication billing. • Ensures Rx Claims approval by performing a series of edits to discover denials during the on-line adjudication process (wrong NDC number, refills too soon, brand vs. generic, etc?), by resolving discrepancies with Purchasing Associates, Pharmacists, Directors of Nursing (DON´s) and/or Nursing Staff. • Identifies and pro-actively resolves denied claims prior to medication delivery, working with Insurance Companies, Medicaid, Nursing Home Facilities and Pharmacy Staff to ensure minimal loss of non-reimbursed inventory. • Follow-up with Directors of Nursing and Nursing Staff to communicate unresolved denials or status changes allowing alternate courses of therapy to be prescribed. • Completes the necessary authorization forms (Certification of Medical Necessity, Prior Authorization Forms, Therapy Change, Authorization of non-covered medications, etc.) to ensure appeals are executed with physicians, DON´s and Claims Processors in a timely manner. • Adhere to policies and procedures in order to conform to Sarbanes Oxley and PharMerica/AmerisourceBergen requirements. • Maintains organized files of appropriate documentation required by state and federal agencies. Minimum Qualifications: • High School Diploma, GED, or Equivalent Experience • 6 Months retail pharmacy technician and/or adjudication experience required • 1-2 years customer service experience required. • Knowledge of insurance billing processes required • POS, Medicaid and Medicare knowledge required • 1 year experience in adjudication in a pharmacy billing environment preferred • Must be available to work nights and weekends Apply online: recruitingsite/csbsites/pharmerica/JobDescription.asp?SuperCategoryCode=14737&JobNumber=709059&source=indeed
Posted on: Thu, 25 Jul 2013 20:13:05 +0000
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