Overview

Adjudication Job at Ltc Pharma Hldg Llc – Fort Lauderdale, FL

WHO WE ARE

Polaris Pharmacy Services is an industry leader in long-term and post-acute care pharmacy.

OVERVIEW

The Third-Party Adjudication Claims Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and its customers. The Third-Party Adjudication Claims Specialist must be responsive and courteous when addressing our customers’ needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers’ trust and respect.

Schedule: 2pm-10:3pm and 8:30pm-5am

RESPONSIBILITIES

Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers

Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines

Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement

Contact providers and/or customers as necessary to obtain additional information

Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes

Work as a team to identify, document, communicate and resolve payer/billing trends and issues

Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner

Review and work convert billing exception reports to ensure claims are billed to accurate financial plans

Complete billing transactions for non-standard order entry situations as required

Support training needs

Prepare and maintain reports and records for processing

Perform other tasks as assigned.

Follow all applicable government regulations, including HIPAA

Comply with departmental policies regarding safety, attendance, and dress code

Overtime, holidays, and weekends may be required and/or expected

Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards

Other duties as assigned; Job duties may vary depending on business needs

QUALIFICATIONS

High School diploma or equivalent required

Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy strongly preferred)

Framework LTC & General computer knowledge & 10-key Number Entry preferred

Knowledge of common brand/generic medications

Knowledge of LTC pharmacy rules, over-rides, and adjudicating claims to resolution

Able to read, write, speak, and understand the English language

Able to retain a large amount of information and apply that knowledge to related situations

Able to work in a fast-paced environment

Basic computer knowledge skills required

Basic math and analytical skills

Experience with alpha-numeric data entry

Proficient in Microsoft Word, Excel, and Outlook required

Customer Service

Results-oriented

Good organization/Attention to detail

Reliable

Problem solver

Able to work various shifts and days

Adaptability to an ever-changing environment

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

May sit or stand seven (7) to ten (10) hours per day

The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently

May be necessary to work extended hours as needed

May lift and/or move up to 50 pounds

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

About the Company

Company: Ltc Pharma Hldg Llc –

Company Location:  Fort Lauderdale, FL

Estimated Salary:

Upload your CV/resume or any other relevant file. Max. file size: 80 MB.

About Ltc Pharma Hldg Llc -