Adjudicate insurance claims and resolve rejections in multi-state environment
Properly handle order exceptions such as refill-too-soon, invalid orders, etc.
Working with prescribers to clarify prescriptions and obtain prior authorizations
Manage routine notification of insurance issues and communicate with caregivers
Stay updated on current Medicare/Medicaid policies and common insurance practices
Work with others to resolve common coverage issues or concerns.

Working knowledge of Medicare Part D, Medicaid, Managed Medicaid
Minimum one year experience in a retail or long-term care pharmacy environment
1+ year of recent experience with FrameworkLTC
Must have or be willing to obtain Texas State Board of Pharmacy Technician License
Type an average of 50 wpm
Excellent phone skills, verbal and written communication skills and active listening
Proficient with Microsoft Office Suite or related software (Outlook, Excel)
Comfortable making phone calls and can handle difficult conversations
Understands basic pharmacy language to interpret prescriptions

Pharmacy Technician – Billing Adjudication

Key skills