At Clarest Health, we are dedicated to transforming patient care by providing innovative and efficient pharmacy services to healthcare facilities. Our commitment to excellence ensures that our automated dispensing solutions streamline medication management, improve patient outcomes, and enhance the overall efficiency of healthcare operations. As a part of the Clarest Health team, you'll be contributing to a mission-driven organization that is redefining the future of pharmacy services and making a meaningful impact on the lives of patients and healthcare professionals across the nation.
The primary goal of the Clarest Pharmacy Adjudication Associate is to understand and utilize all processes associated with adjudicated rejected claims, system alerts and other communications. The Adjudication Associate is responsible for working with each of our pharmacy locations to provide resolution or added information needed to assure payment before each scheduled pharmacy delivery cutoff. This function is directly interfaced with the pharmacy workflow for fulfillment and distribution of medications and as a result, timeliness and accuracy are paramount.
Location: Remote
Salary: $22 – 24 per hour (based on experience) + Shift differential for weekend and late-night hours
Schedule: 2nd shift: 4PM EST – 12:30AM EST (With Rotating Weekends)
What We Offer:
- Comprehensive Medical, Dental and Vision Insurance (as low as $13.33/pay)
- Paid Time Off
- Free Virtual Care – Telemedicine
- 401k with company match
- Referral Bonuses
- Life Insurance
- Make a difference in the lives of others!
- We are growing and that means more opportunities
Key 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.
Qualifications:
- High school diploma or equivalent, required.
Skills + Abilities:
- Knowledge of Medicare Part D, Medicaid, and Commercial insurances, required.
- Intermediate knowledge of Microsoft Outlook, and Teams, required.
- Intermediate experience with Framework LTC and DocuTrack preferred.
- Ability to maintain confidentiality including but not limited to HIPPA.
Clarest is an Equal Opportunity Employer. Reasonable accommodations will be made to enable individuals with disabilities to apply for a job or to perform the essential functions of their job. Please advise us if you require a reasonable accommodation.
