Adjudication Associate

Job Description

REQUIREMENTS

• At least 1 year of experience in a pharmacy-based environment.
• Basic proficiency with desktop software applications, particularly Microsoft Excel and Microsoft Access.
• Must be able to work Monday-Friday from 9:00pm-5:30am Eastern Standard Time, as well as be willing to work weekends (once every three weeks) and holidays (several times per year).
• High school diploma or GED.

Preferred

• Pharmacy technician certification.
• Previous experience in managed care and Medicaid and/or Medicare organizations.
• Ability to perform multiple tasks effectively.
• Ability to work both independently and as part of a team.
• Ability to operate independently.
• Dedicated and reliable nature.

RESPONSIBILITIES

• Follows established procedures to execute routine business support tasks for the Adjudication Omnicare function under general supervision.
• Develops effective relationships with all team members to ensure daily communication to resolve issues and prevent delays in service.
• Conducts review and research of rejected claims and takes action for resolution.
• Handles work backlog of denied claims for timely resubmission.
• Ensures compliance with all government and regulatory requirements.
• Takes direction to execute techniques, processes, and responsibilities.

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