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Pharmacy Data Entry/Adjudicator

Company: Symbria
Location: Green Bay
Posted on: September 14, 2019

Job Description:

Overview Symbria Rx Services  is seeking a team oriented, experienced  Remote Data Entry/Adjudicator  who shares our commitment to ensuring the health and wellness of seniors.  This position is responsible for the computer data entry of prescription orders and medical records, communicating to the communities when order exceptions occur such as non-formulary, expensive medications, and incomplete orders. This position works closely with the community staff to have orders clarified and medications changed to less expensive alternatives. Coordinates all adjudication on Medicare D claims where needed and to perform all functions required to maintain, update, and bill customers’ accounts timely and accurately. As one of the few 100% employee-owned companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to. For more than 20 years, Symbria has been providing an outstanding work environment for talented employees to deliver patient-centered care to the geriatric population in senior-living and post-acute settings. (***This is a remote position that must live 100 mile radius away from Woodridge, Illinois or  must live in either Indiana, Missouri, Ohio, Colorado or Wisconsin) HOURS:  2:00pm-10:30pm, Monday through Friday, rotating weekends & holidays (hours differ) Responsibilities DATA ENTRY FUNCTIONS AND RESPONSIBILITIES Contact physician’s office as needed for refill authorization. Contact client for verification of orders as needed. Process all new and refill prescriptions. Open orders as needed, verify eligibility, proof and input prescriptions while maintaining productivity and quality standards. Document correspondence and follow up in the system. Prepare audit sheets and provide feedback to manager. Forward incomplete or rejected scripts to appropriate department for resolution and track status in the system. Initiate and document correspondence and follow up in system. May assist with research of lost or missing orders per internal department requests. May provide backup support to other pharmacy groups based on business needs or production levels. Answer incoming calls promptly and provide high standard of customer service to the client. ADJUDICATION FUNCTIONS AND 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 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 EDUCATION AND OTHER QUALIFICATIONS REQUIRED High School diploma or general education degree (GED). Pharmacy Technician License and/or Certification (CPhT) as per State requirements. General computer knowledge including Microsoft Office: Word, Excel and Outlook. Excellent customer service, interpersonal, verbal and written communication skills. Work collaboratively with other team members and manager to ensure that best practices are shared. Ability to read and interpret prescription terminology and medications and strong knowledge of brand/generic drugs. Exceptional time and data management skills, organizational and problem-solving skills, ability to prioritize workload and comfortable working independently. Ability to multi-task while talking and listening to clients while accessing, reading and inputting information into numerous computer software applications. Must be able to work weekends, holidays and alternate shifts for PTO/staffing coverages as 24/7/365 operational needs dictate. Remote (home office) qualifications required Must currently live outside a radius of 100 miles or more from the Woodridge, Illinois pharmacy location. Must currently live in a state Symbria Rx Services is licensed in. Illinois Pharmacy Technician license must be active and valid or in applied-for status with proof of application prior to start date. Permanent residence with a defined working space and mailing address. Must be willing and have ability to commute to the Woodridge, IL pharmacy location (or alternate company designated location) at a minimum once per year and no more than two times annually for any mandatory meeting and/or training. Ability to complete I-9 work authorization in person preferably at either a Symbria Rx pharmacy location or Symbria Rehab community or may use a notary office as alternative. Signed acknowledgement of Telecommuting Policy QUALIFICATIONS Preferred Pharmacy data entry experience; minimum one year. Strong knowledge of Brand/Generic drugs and medical terminology. Experience with FrameworkLTC and Docutrack systems, minimum two years. Technical qualifications (applicants must meet all technical qualifications at time of application) Standardized technology equipment provided by the company includes: Desktop computer Two monitors Phone with teleworker license Display port cables Keyboard and mouse Must have high-speed, internet access provided by a cable or fiber provider (no DSL or satellite). Internet is not provided or reimbursed by Symbria. Users with no more than three (3) local devices connected, a minimum connection speed 25 Mbps for downloads, and 5 Mbps for uploads is required. Users with four (4) or more devices such as laptops/ computers, mobile phones/ tablets, VOIP home phone, gaming systems, and streaming video systems (Netflix, Amazon Fire/ TV, Google, Roku, Apple TV, etc.), the minimum connection speed required should be 75 Mbps for downloads and 5-10 Mbps for uploads. We recommend a wire connection to your home internet router. Slow or poor internet connection may impact or prohibit the ability to perform your job. The use of Wi-Fi ‘air cards’ (mobile hot spots) are prohibited. Symbria reserves the right to verify that your system will meet or exceed these requirements. Why work at Symbria? 100% employee-owned company through an Employee Stock Ownership Plan, also known as an ESOP. You, along with your co-workers, have an ownership stake in this company! Competitive compensation ESOP retirement plan 401(k) & Roth 401(k) plans Employee Assistance Program Full-time employees are eligible for medical, dental, vision, life insurance, short/long term disability, flexible spending accounts (FSA), Paid Time Off (PTO) + 6 Holidays and Yearly Tuition Reimbursement EOE APPHPPH

Keywords: Symbria, Green Bay , Pharmacy Data Entry/Adjudicator, Other , Green Bay, Wisconsin

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