Remote - LTC Pharmacy Adjudicator

Symbria • Full-time • Remote (Woodridge, IL, US) • 2d ago

Overview

Symbria Rx Services is seeking a team oriented. As one of the few 100% employee-owned companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to. For more than 20 years, Symbria has been providing an outstanding work environment for talented employees to deliver patient-centered care to the geriatric population in senior-living and post-acute settings.

The LTC Pharmacy Adjudicator is responsible for communicating to the communities when order exceptions occur such as non-formulary, expensive medications, and incomplete orders. This position works closely with the community staff to have orders clarified and medications changed to less expensive alternatives. Coordinates all adjudication on Medicare D claims where needed and to perform all functions required to maintain, update, and bill customers’ accounts timely and accurately.

Position Details:

10:00am-6:30PM Mon-Fri and every 3rd weekend.
Must work holidays
Must currently live in a state Symbria Rx Services is licensed in: AZ, CO, FL, IL, IN, KS, MA, MI, MO, PA, OH, WI.
100% Remote

Responsibilities

Initiate communication to communities regarding expensive and non-formulary medication orders and educate on less expensive alternatives identified by staff pharmacists.
Initiate communication to community regarding incomplete orders which require further clarification.
Keep detailed records of all orders that require communication to the community for potential follow up if needed.
Follow up with the community per policy timeframe if the medications have not been changed or clarified. Send another supply of medication if needed.
Communicate professionally with community management staff including Director of Nursing and Administrator via phone or email.
Assist with data entry of orders as needed.
Assist with answering phone calls for the data entry department.
Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians to successfully adjudicate all claims.
Work in conjunction with designated operations staff to prepare for formulary changes.
Perform insurance and billing clerical duties, including review and maintenance of patient account information.
Prepare and submit claims to various third parties either electronically or by paper.
Identify and resolve claim denials.
Act as liaison between patients and third parties.
Work collaboratively with other team members and supervisor to ensure best practices are shared.
Provide backup support to other pharmacy departments based on business needs or production levels, as needed.
Any and all duties as assigned.

Qualifications

EDUCATION AND OTHER QUALIFICATIONS REQUIRED:To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required:

High School diploma or general education degree (GED).
Pharmacy Technician License and/or Certification (CPhT) as per State requirements (must be licensed in Illinois and Massachusetts within 60 days of hire).
Data entry experience; minimum one year.
Excellent customer service, interpersonal, verbal and written communication skills.
General computer knowledge including Microsoft Office: Word, Excel, and Outlook.
Ability to maintain organization, multi-task and prioritize to manage assignments/projects.
Strong knowledge of Brand/Generic drugs and medical terminology.

QUALIFICATIONS PREFERRED:

Prescription billing experience; minimum one year.

Why work for us?

At Symbria our employees act like owners – because we are owners! As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options.

Symbria’s Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together:

Integrity – Honest, Fairness and ethics

Compassion – Commitment to serving seniors

Stewardship – Maximizing mission and margin

Innovation – Striving to enhance our value to your organization

Teamwork – Working together unselfishly toward goals

As an employee-owner, Symbria’s success becomes your success. In addition, we provide:

Competitive pay, aligned with market guidelines
Full Benefits Package, including very generous paid time off plans
Professional liability coverage
100% employer-funded ESOP retirement plan
401(k) and Roth(k) plans
Continuing education
Credit union membership

All applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, sexual orientation, marital status, order of protection status, national origin or ancestry, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service.

#LI-REMOTE

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