Clarest Health · 4 hours ago

Pharmacy Adjudication Associate (Remote)

Vienna, VA

Full-time

Remote

Entry Level

$22/hr - $24/hr

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Responsibilities

The ability to adhere to Clarest’s Code of Conduct, follow Clarest Compliance policies and procedures, and report any suspected violations of any federal or state laws to either their direct supervisor, Human Resources or the Compliance Officer

Work rejections to the farthest possible outcome before triaging issue to other billing teams.

Work refill too soon rejections appropriately

Create detailed, accurate forms for non-covered medications and communicate these forms to the appropriate recipients (internal and external)

Adhere to the departmental processes associated with the documentation and review of claims processing.

Provide proper notation on prescriptions in the document server as well as in the billing comment sections of prescriptions.

Triage documents correctly in the document server

Ensure timely input of information into our pharmacy fulfillment software based on information to assure on-time fulfillment of prescription to the patient.

Communicate efficiently and effectively with team members, pharmacists, nursing facility staff and insurance companies.

Research system for member eligibility. Create and record patient and insurance information.

Escalate issues pertaining to workflow to Adjudication Leadership.

Respond to Adjudication related emails in a timely manner.

Any and other responsibilities as assigned by the manager to support these and other responsibilities in the department.

Qualification

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