Experienced Remote LTC Pharmacy Adjudicator - Patient-Centered Care and Medication Management Expert
About Symbria Rx Services Symbria Rx Services is a leading provider of innovative pharmacy services to the geriatric population in senior-living and post-acute settings. As one of the few 100% employee-owned companies in healthcare, our business practices are guided by the values to which our employee owners are committed to. For over 20 years, Symbria has been dedicated to delivering exceptional patient-centered care and creating a positive work environment for talented employees to thrive. Job Summary We are seeking an experienced and detail-oriented Remote LTC Pharmacy Adjudicator to join our team. As a key member of our pharmacy services team, you will play a vital role in communicating with communities regarding medication orders, educating on less expensive alternatives, and ensuring timely and accurate billing of customer accounts. This is an excellent opportunity for a motivated and customer-focused individual to grow their career in a dynamic and innovative company. Responsibilities Initiate communication to communities regarding expensive and non-formulary medication orders and educate on less expensive alternatives identified by staff pharmacists. Initiate communication to community regarding incomplete orders which require further clarification. Keep detailed records of all orders that require communication to the community for potential follow up if needed. Follow up with the community per policy timeframe if the medications have not been changed or clarified. Send another supply of medication if needed. Communicate professionally with community management staff including Director of Nursing and Administrator via phone or email. Assist with data entry of orders as needed. Assist with answering phone calls for the data entry department. Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians to successfully adjudicate all claims. Work in conjunction with designated operations staff to prepare for formulary changes. Perform insurance and billing clerical duties, including review and maintenance of patient account information. Prepare and submit claims to various third parties either electronically or by paper. Identify and resolve claim denials. Act as liaison between patients and third parties. Work collaboratively with other team members and supervisor to ensure best practices are shared. Provide backup support to other pharmacy departments based on business needs or production levels, as needed. Any and all duties as assigned. Qualifications To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required: Essential Qualifications High School diploma or general education degree (GED). Pharmacy Technician License and/or Certification (CPhT) as per State requirements (must be licensed in Illinois and Massachusetts within 60 days of hire). Data entry experience; minimum one year. Excellent customer service, interpersonal, verbal and written communication skills. General computer knowledge including Microsoft Office: Word, Excel, and Outlook. Ability to maintain organization, multi-task and prioritize to manage assignments/projects. Strong knowledge of Brand/Generic drugs and medical terminology. Preferred Qualifications Prior experience in prescription billing; minimum one year. Why Work for Symbria? At Symbria, our employees act like owners – because we are owners! As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options. Our Core Values Symbria's Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together: Integrity – Honest, Fairness and ethics Compassion – Commitment to serving seniors Stewardship – Maximizing mission and margin Innovation – Striving to enhance our value to your organization Teamwork – Working together unselfishly toward goals Benefits and Perks As an employee-owner of Symbria, you will enjoy: Competitive pay, aligned with market guidelines Full Benefits Package, including very generous paid time off plans Professional liability coverage 100% employer-funded ESOP retirement plan 401(k) and Roth(k) plans Continuing education Credit union membership Equal Opportunity Employer All applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, sexual orientation, marital status, order of protection status, national origin or ancestry, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service. Apply Now Don't miss out on this exciting opportunity to join our team. Apply now and take the first step towards a rewarding career as a Remote LTC Pharmacy Adjudicator at Symbria Rx Services. Apply for this job