Ohio Licensed Pharmacy Adjudication Specialist

Job Summary

Seeking an Ohio Licensed Pharmacy Adjudication Specialist, this full-time position may work remotely and is responsible for adjudicating pharmacy claims, resolving third-party rejections, and ensuring accurate patient setup and communication regarding medication delivery.

Key responsibilities

• Adjudicates pharmacy claims for primary, secondary, and tertiary plans while reviewing claim responses for accuracy
• Contacts insurance companies to resolve claim rejections and performs outreach to patients regarding medication delivery delays
• Ensures accurate patient setup in the CPR+ system and manages funding-related adjudications as a liaison to the Advocate team

Required qualifications

• High School Diploma or GED with previous experience in pharmacy, medical billing, or benefits verification
• 2+ years of experience in a pharmacy or healthcare setting or pharmacy claims experience
• Pharmacy Technician License/Registration with the Board of Pharmacy as required by state law
• Knowledge of pharmacy/NDC medication billing and understanding of Medicare, Medicaid, and commercial insurance
• Intermediate typing/keyboarding skills and familiarity with pharmacy terminology