Adjudication Team Lead

Reporting to the Adjudication Supervisor, the Adjudication Team Lead plays a pivotal role in ensuring the accurate billing of prescriptions and overseeing a team of adjudication technicians. The Adjudication Team Lead is responsible for directing the adjudication team to ensure daily functions such as working rejection, handling change in prescriptions, issues, payer changes and workflow monitoring. This role encompasses the company’s goal of accurate billing data along with superior customer service in a timely manner.

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Predictable, reliable, and punctual attendance is an essential function of the job role.

• Holds technicians responsible for resolving any form of a pharmacy rejection claim.
• Guide daily workflow to ensure all pharmacies runs are complete in a timely manner.
• Keeps team running efficiently and on task with help of supervisors.
• Ensure cut-offs are adhered to and billing is completed promptly to help ensure timely run departures.
• Answers all questions technicians may have
• Oversee shift staffing needs/adjustments based on pharmacy dashboard and/or occurrences
• Help train technicians as needed.
• Review and process emails send to the rejects email account.
• Display behavior which exemplifies employee code of conduct guidelines.
• Regular attendance and punctuality are required: arrive to work on time, work scheduled hours.
• Ability to work mandatory overtime when required.
• All other duties as assigned.

MINIMUM REQUIREMENTS:

Education & Experience: High School Diploma or G.E.D. and 1-3 years of data entry experience; or an equivalent mix of education and experience. Long term care pharmacy experience preferred, PTCB certification preferred.

Computer Skills: Intermediate computer proficiency. Pharmacy and medication distribution software (EMAR, Pyxis Medbank, Frameworks preferred.

Language Skills: Ability to read and interpret documents such as medication documentation, business correspondence and procedure manuals; ability to write routine reports and business correspondence; ability to speak effectively, both in person and by telephone, to customers or employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs; ability to understand and interpret statistical reports, data charts and graphs.

PHYSICAL DEMANDS:

The physical demands and work environment described here are representative of those an employee encounters while performing the essential functions of this job.

The regular work schedule for this position is approximately 40 hours per week (Monday-Friday) and may require additional hours/overtime as necessary. Must regularly lift and/or move up to 20 pounds. Specific vision abilities required by this job include: Close vision, Distance vision, Peripheral vision, Depth perception, Ability to adjust focus and Ability to match or detect differences between colors, including shades of color and brightness. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand, bend, and walk.