Claims Adjudicator

AmeriPharma•Laguna Hills, CA

1d•$29 - $32•Onsite

About The Position

The Claims Adjudicator facilitates the claims adjudication process through effective claims management. The incumbent will ensure claim accuracy, bill payors, and coordinate with the Copay Assistance Department as necessary.

Requirements

Well-organized and strong attention to detail
NCPDP Claim Submission Experience
High School diploma or equivalency

Nice To Haves

Prior authorization/override experience preferred
CPR+ experience preferred

Responsibilities

Claims analysis (cost of goods, total allowed amount, portion paid by the insurance, patient’s copay)
Test claim refill orders
Troubleshoot claim rejections
Bill primary and secondary payors
Review coverage of primary and secondary payors
Coordinate with Copay Assistance Department when copay funds are depleted to obtain additional funds
Coordinate with the Patient Care Coordinator Supervisor the order claim status if there is a delay in scheduling
Identify and add new payors when the patient’s insurance has changed
Ensure accuracy of NCPDP claim submission
Review order profitability
Proper documentation of patient’s medication coverage in progress notes
Ensure compliance with the 14-day window of adjudication and scheduled delivery
Manage claims exception
Reports underpaid claims, changes in reimbursement from previous claims, pricing issues, and billing or copay assistance issues to supervisor