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Pharmacy Adjudicator Technician

Description:

 Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.

 Researches, analyzes and appropriately resolves 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.

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

 Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes

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

 Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans

 Prepares and maintains reports and records for processing.

 Performs other tasks as assigned.

 Prepares and maintains reports and records for processing.

 Performs other tasks as assigned.

Skills:

Pharmacy, Pharmacy technician certification, Customer service, Prior authorization, Data entry, Health care, Retail pharmacy

Additional Skills & Qualifications:

• High school diploma or equivalent

• Pharmacy related experience

• Basic understanding of drugs, medication terminology, and metric system; ability to operate a

computer

• Licenses/Certifications: As required by state regulations and business needs

• Detail oriented; goal oriented, team player, customer service, oral communication

Experience Level:

Entry Level

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.