Full-Time Adjudicator/Data Entry Tech - Tyler, TX
PharMerica - Tyler, TX

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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 Tyler is recruiting for a Full-Time Adjudicator/Data Entry Technician to join our team. 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 every 3rd weekend
Interested candidates please apply on-line @ www.pharmerica.com

PharMerica - 2 years ago - save job
About this company
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The only time you'll see PharMerica's products is when a nurse hands you a pill in a paper cup. It is the country's...