Job Summary
The Pharmacy Adjudication Specialist plays a crucial role in managing and adjudicating pharmacy claims while addressing third-party rejection issues. This position is key in ensuring the precise coordination of benefits, facilitating patient communication regarding possible delays in medication delivery, and acting as a link for any discrepancies in financial responsibility and copayment amounts.
Responsibilities
- Adjudicate pharmacy claims and resolve any third-party denials.
- Ensure accurate coordination of benefits for patients.
- Conduct patient outreach to inform them about medication delivery delays.
- Act as a liaison regarding financial responsibilities and copayment discrepancies.
Qualifications
- High School Diploma or GED is required.
- A minimum of 2 years of experience in a pharmacy or healthcare environment.
- Proficiency in pharmacy claims resolution and a solid understanding of insurance processes.
- Basic math skills are essential for effective claim adjudication.
- Must possess state-mandated Board of Pharmacy registration.
