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.
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.
Education and Experience
High School Diploma or equivalent
Certified and Registered Pharmacy Technician, (Colorado) in good standing required
Registered with the State of Florida (Florida techs only) in good standing required, certification preferred
Previous Prior Authorization or Claims experience is preferred
Knowledge, Skills, and Abilities
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.
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
Location
Lakeland, Florida
Website
https://www.welldyne.com
Skills
Accounts Receivableunmatched
Adjudicationunmatched
Billingunmatched
Certified Pharmacy Technician (CPhT)unmatched
Co-Paymentsunmatched
Communication Skillsunmatched
Corporate Policiesunmatched
Cost of Goods Sold (COGS)unmatched
Customer Support/Serviceunmatched
Data Qualityunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Identify Issuesunmatched
Insuranceunmatched
Manual Dexterityunmatched
Medical Assistanceunmatched
Medical Billingunmatched
Multitaskingunmatched
Office Equipmentunmatched
Organizational Skillsunmatched
Pharmacyunmatched
Physical Demandsunmatched
Problem Solving Skillsunmatched
Process Improvementunmatched
Quality Managementunmatched
Reconciliationunmatched
Time Managementunmatched
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