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Form of workJob Description
Summary
Under the direction of Manager, Front End operations, accurately bills insurance claims to patient accounts and troubleshoots rejected claims.
Essential Duties & Responsibilities- Manages the adjudication inboxes
- Assists with medical claims billing
- Responsible for troubleshooting orders with a rejected status; refill too soon, increase/decrease of dose, duplicate claim, and eligibility issues.
- Responsible for the reconciliation of the master claims queue
- Assist with billing projects, ie. Member AR report, COGS, etc.
- Ensures insurance information is accurate for correct adjudication.
- Assists patients in the re-enrollment of copay cards and patient assistance plans
- Communicates with patient assistance plans when necessary to obtain payment
- Assists with the timely initiation and resolution of prior authorizations
- Works with appropriate staff members to resolve claims issues
- Follow and aid in enforcement of all company policies and procedures.
- Respect and maintain confidentiality guidelines of HIPAA.
- Responsible for other duties as assigned.
- High School Diploma or equivalent required
- Pharmacy Technician License or National Certified Pharmacy Technician (CPhT) - Preferred
- Previous experience with Prior Authorization or Claims adjudications experience is preferred
- Previous experience with PBM, Pharmacy Billing and overrides.
- Demonstrates a high degree of personal responsibility regarding accuracy and quality of work.
- Demonstrates ability to work effectively and maintain expected productivity.
- Ensures accuracy of information being provided to Management for review.
- Schedules own time based on priorities.
- Demonstrates Excellent customer service and Professionalism
- Ability to multi-task
- Ability to communicate effectively, patiently, and courteously.
- Ability to work in a high pace, stressful environment.
- Should be independent and self-motivated.
- Maintains a good attendance record.
WellDyne Can Offer You
- Medical, Dental and Vision Benefits
- Medical Savings Account Options with Company match
- 401K after 90 days of employment
- Employee Assistance Program
- Life and Supplemental insurance
- Educational Reimbursement
- Paid Time Off
This position is in a typical office environment which requires prolonged sitting and standing in front of a computer. In addition, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients and employees. This position may be required to work long hours.
