Adjudication/Reimbursement Specialist

State registration requiredPharmacy technician certification must be obtained within 1 year of hireFlexible scheduling - afternoon shift with rotating weekendsThe responsibility of the Reimbursement specialist is to verify all patient information is accurate and billing information correct, allow all prescriptions to be billed to the correct payer source in regards to pricing, billing regulations and utilization guidelines.Primary Duties and ResponsibilitiesInsurance VerificationsAddress calls from facilities, guarantors and Insurance companies.Initiate Prior AuthorizationsReview Audits from Insurance companiesReconciling online third party claimsInsurance Rejections from remittanceMedicaid Rejections from remittanceOther duties as assignedSkill RequirementsCertification required within 1 year of hire dateMust be able to Multi-taskExcellent written and oral communication skillsDetail orientedSelf-motivatedWork well in team environment and independentlyBasic Microsoft Word and Excel experienceA Reimbursement Specialist functions as an integral part of the team working towards a common goal: Customer Service, Quality and Employee Satisfaction

Created: 2025-02-04