Adjudication Technician at EmpowerMe Wellness

Maryland Heights, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Apr, 26

Salary

0.0

Posted On

20 Jan, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Attention To Detail, Time Management, Organizational Skills, Communication Skills, Problem Solving, Critical Thinking, Teamwork, Interpersonal Skills, Pharmacy Technician License, Insurance Claims Processing, HIPAA Compliance, Medical Billing, EMR Systems, Prior Authorization, Pharmacy Operations

Industry

Hospitals and Health Care

Description

Overview A tech-enabled, multidisciplinary healthcare organization, EmpowerMe Wellness is on a mission to improve the lives of seniors. EmpowerMe enriches senior living communities nationwide through our fully integrated healthcare model, which features on-site care coordination, therapy, and pharmacy services. Headquartered in St. Louis, Missouri, our 3,500+ team members drive positive outcomes and build healthier, happier tomorrows for older adults. To learn more, visit empowerme.com today. Responsibilities The Adjudication Technician is responsible for accurately processing prescription claims and ensuring successful adjudication through pharmacy benefit managers (PBMs) and insurance providers. This role involves troubleshooting rejected claims, verifying patient and insurance information, and working closely with pharmacists, prescribers, and insurance companies to resolve issues quickly and efficiently. Your essential duties include the following: • Process and resolve third-party insurance claims and rejections. • Verify patient insurance information and ensure accurate claim adjudication. • Initiate and follow-up on prior authorizations with prescribers’ offices. • Communicate with PBMs, insurers, and healthcare providers to resolve issues. • Maintain compliance with HIPAA, billing regulations, and documentation standards. • Assist with audits and support general pharmacy operations as needed. • Perform other duties as assigned that are consistent with qualifications, professional practices, and ethical standards o Tasks and responsibilities are subject to change at your supervisor’s discretion o Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions Qualifications • High school diploma or equivalent • 1+ year Pharmacy Tech experience (preferred) • Pharmacy Technician License (preferred) • Exemplary attention to detail • Strong time management and organizational skills with ability to prioritize tasks as needed • Well-received/respected by coworkers with willingness to maintain positive morale • Excellent verbal and written communication skills • Strong problem-solving and critical thinking abilities • Ability to retain information such as words, numbers, and procedures • Teamwork mindset with strong interpersonal skills Computer Skills: • Proficiency in Internet browsers (e.g. Explorer, Chrome, Fire Fox) • Advanced knowledge of Microsoft Office programs: Outlook, Excel, Word and Publisher applications • Experience in working with various EMR and medical billing systems would be a plus.

Responsibilities

The Adjudication Technician is responsible for processing prescription claims and ensuring successful adjudication through pharmacy benefit managers and insurance providers. This includes troubleshooting rejected claims and verifying patient and insurance information.