Role Description
The Adjudication Associate (Omnicare) is responsible for the preparation and submission of claims for accounts to ensure timely reimbursements. This person will communicate with the nursing facility staff, physician offices, and insurance companies to maintain payment deliverables for online claim submissions.
• Follows established procedures to execute routine business support tasks for the Adjudication Omnicare function under general supervision.
• Develops effective relationships with all team members to ensure daily communication to resolve issues and prevent delays in service.
• Conducts review and research of rejected claims and takes action for resolution.
• Handles work backlog of denied claims for timely resubmission.
• Ensures compliance with all government and regulatory requirements.
• Takes direction to execute techniques, processes, and responsibilities.
Qualifications
• At least 1 year of experience in customer service.
• Basic proficiency with desktop software applications, particularly Microsoft Excel and Microsoft Access.
• Must be able to work overnight (9pm-5:30am EST), as well as be willing to work weekends and holidays on a rotating schedule.
Requirements
• Pharmacy technician certification (preferred).
• Experience in pharmacy, managed care, Medicaid and/or Medicare organizations (preferred).
• Ability to perform multiple tasks effectively.
• Ability to work both independently and as part of a team.
Education
• High School Diploma or GED.
Benefits
• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.