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Arbiter/Failed Claims Technician

WellDyne
  • Lakeland, Florida
    7 days ago

    Job Description

    At our company, we move fast, adapt quickly, and turn challenges into opportunities—all while keeping quality at the heart of everything we do. We believe that work should be a positive and respectful place, and that with the right mindset, anything is achievable. 
    Our Vision:  
    Fulfill the essential promise of pharmacy care and help people to live to their healthiest, happiest, and fullest potential. 
    Our Mission:  
    To be the disruptive force that drives meaningful change within pharmacy services. 
     
    Summary
    Under the direct supervision of the Pharmacy Supervisor (FL), update prescription orders following all pharmacy procedures and guidelines.

    Essential Duties and Responsibilities
    • Perform routine, professional pharmacy functions.
    • Respect and maintain confidentiality guidelines of HIPAA.
    • Follow and aid in enforcement of all company policies and procedures.
    • Answer all emails in the arbiter email box in a timely and accurate manner.
    • Responsible for orders in failed claims and high co-pay queue.
    • Ensure insurance information is accurate for correct adjudication.
    • Accountable for checking patient history for refill too soon, increase/decrease of dose, and duplicate scripts.
    • Ensure all prior authorizations are started in a timely and accurate manner.
    • Responsible for other duties as assigned.
    Education and Experience
    • High School Diploma or equivalent
    • Registered Pharmacy Technician with the State of Florida.
    • Preferred – national certification (CPhT)
    • One year minimum of pharmacy experience
    • Knowledge of health insurance plans
    • Familiarity with Microsoft Word, Excel, and Outlook
    Knowledge, Skills, and Abilities
    • Attention to detail.
    • Ability to handle multiple activities or interruptions at once.
    • Ability to communicate effectively, patiently and courteously.
    • Focused team player, who can work in conjunction with pharmacists, other departments, customers, and management.
    • Work independently with little supervision and meet daily deadlines.
    • Ability to perform repetitious work accurately.

    Work Environment / Physical Demands
    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

    Numbers & Facts

    LocationLakeland, Florida
    Websitehttps://www.welldyne.com

    Skills

    • Adjudicationunmatched
    • Certified Pharmacy Technician (CPhT)unmatched
    • Co-Paymentsunmatched
    • Communication Skillsunmatched
    • Corporate Policiesunmatched
    • Data Qualityunmatched
    • Detail Orientedunmatched
    • HIPAA (Health Insurance Portability and Accountability Act)unmatched
    • Health Insuranceunmatched
    • Insuranceunmatched
    • Manual Dexterityunmatched
    • Microsoft Excelunmatched
    • Microsoft Outlookunmatched
    • Microsoft Wordunmatched
    • Office Equipmentunmatched
    • Patient Assessmentunmatched
    • Patient Historyunmatched
    • Pharmacyunmatched
    • Physical Demandsunmatched
    • Process Improvementunmatched
    • Quality Managementunmatched
    • Scripting (Scripting Languages)unmatched
    • Team Playerunmatched
    • Time Managementunmatched

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