Responsible for reviewing, interpreting, and posting Pharmacy Benefit Manager payments in a high-volume, time-sensitive environment. This role focuses on accurate payment application, claim review, deposit verification, denial posting, and maintaining organized documentation and reports.
Key responsibilities include:
- Review patient and prescription data in the pharmacy system.
- Review claim submissions for accuracy.
- Review and post payments in the Pharmacy Benefit Manager portal.
- Verify deposits in the Pharmacy Benefit Manager portal.
- Download 835 files and upload them to the Epic FTP folder.
- Load and post bank cash files.
- Post payments and denials accurately.
- Apply adjustments according to carrier adjudication and posting procedures.
- Review and clear payment errors.
- Prepare reports and written documentation as needed.
- Review and submit prior authorizations as needed.
- Perform other duties assigned by the Director of Pharmacy or Pharmacy Business Supervisor.
Requirements & Qualifications
Education
- High school diploma or GED required.
Experience
- Minimum 2 years of claim adjudication or billing experience required.
- 2 years of relevant medication prior authorization experience preferred.
- Familiarity with EPIC/Epic systems preferred.
Licensure / Certification
- Current Pharmacy Technician license from the California Board of Pharmacy preferred.
Skills
- Bilingual English/Spanish preferred.
- Strong oral and written communication skills.
- Ability to organize and prioritize work to meet deadlines.
- Knowledge of Medi-Cal, Medicare, and commercial insurance regulations preferred.
- Knowledge of medical terminology preferred.
- Ability to follow directions accurately.
Physical / Working Conditions
- Prolonged sitting using a PC.
- Constant walking and standing.
- Ability to lift up to 15 lbs.
- Occasional driving and travel to other sites may be required.
- Must meet pre-employment screening and vaccination requirements.
Location
San Diego, California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago
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