Pharmacy Data Entry/Adjudicator
Posted on: October 14, 2019
Symbria Rx Services is seeking a team oriented, experienced Remote
Data Entry/Adjudicator who shares our commitment to ensuring the
health and wellness of seniors. This position is responsible for
the computer data entry of prescription orders and medical records,
communicating to the communities when order exceptions occur such
as non-formulary, expensive medications, and incomplete orders.
This position works closely with the community staff to have orders
clarified and medications changed to less expensive alternatives.
Coordinates all adjudication on Medicare D claims where needed and
to perform all functions required to maintain, update, and bill
customers' accounts timely and accurately.
As one of the few 100% employee-owned companies in healthcare, our
business practices are guided strictly by the values to which our
employee owners are committed to. For more than 20 years, Symbria
has been providing an outstanding work environment for talented
employees to deliver patient-centered care to the geriatric
population in senior-living and post-acute settings.
(***This is a remote position that must live 100 mile radius away
from Woodridge, Illinois or must live in either Indiana, Missouri,
Ohio, Colorado or Wisconsin)
HOURS: 2:00pm-10:30pm, Monday through Friday, rotating weekends &
holidays (hours differ)
DATA ENTRY FUNCTIONS AND RESPONSIBILITIES
--- Contact physician's office as needed for refill
--- Contact client for verification of orders as needed.
--- Process all new and refill prescriptions.
--- Open orders as needed, verify eligibility, proof and input
prescriptions while maintaining productivity and quality
--- Document correspondence and follow up in the system.
--- Prepare audit sheets and provide feedback to manager.
--- Forward incomplete or rejected scripts to appropriate
department for resolution and track status in the system.
--- Initiate and document correspondence and follow up in
--- May assist with research of lost or missing orders per internal
--- May provide backup support to other pharmacy groups based on
business needs or production levels.
--- Answer incoming calls promptly and provide high standard of
customer service to the client.
ADJUDICATION FUNCTIONS AND RESPONSIBILITIES
--- Initiate communication to communities regarding expensive and
non-formulary medication orders and educate on less expensive
alternatives identified by staff pharmacists.
--- Initiate communication to community regarding incomplete orders
which require further clarification.
--- Keep detailed records of all orders that require communication
to the community for potential follow up if needed.
--- Follow up with the community per policy timeframe if the
medications have not been changed or clarified. Send another supply
of medication if needed.
--- Communicate professionally with community management staff
including Director of Nursing and Administrator via phone or
--- Assist with answering phone calls for the data entry
--- Review Medicare D rejections and prior authorizations, and
coordinate with pharmacists or physicians to successfully
adjudicate all claims.
--- Work in conjunction with designated operations staff to prepare
for formulary changes.
--- Perform insurance and billing clerical duties, including review
and maintenance of patient account information.
--- Prepare and submit claims to various third parties either
electronically or by paper.
--- Identify and resolve claim denials.
--- Act as liaison between patients and third parties.
--- Work collaboratively with other team members and supervisor to
ensure best practices are shared.
--- Provide backup support to other pharmacy departments based on
business needs or production levels, as needed.
--- Any and all duties as assigned.
EDUCATION AND OTHER QUALIFICATIONS REQUIRED
--- High School diploma or general education degree (GED).
--- Pharmacy Technician License and/or Certification (CPhT) as per
--- General computer knowledge including Microsoft Office: Word,
Excel and Outlook.
--- Excellent customer service, interpersonal, verbal and written
--- Work collaboratively with other team members and manager to
ensure that best practices are shared.
--- Ability to read and interpret prescription terminology and
medications and strong knowledge of brand/generic drugs.
--- Exceptional time and data management skills, organizational and
problem-solving skills, ability to prioritize workload and
comfortable working independently.
--- Ability to multi-task while talking and listening to clients
while accessing, reading and inputting information into numerous
computer software applications.
--- Must be able to work weekends, holidays and alternate shifts
for PTO/staffing coverages as 24/7/365 operational needs
Remote (home office) qualifications required
--- Must currently live outside a radius of 100 miles or more from
the Woodridge, Illinois pharmacy location.
--- Must currently live in a state Symbria Rx Services is licensed
--- Illinois Pharmacy Technician license must be active and valid
or in applied-for status with proof of application prior to start
--- Permanent residence with a defined working space and mailing
--- Must be willing and have ability to commute to the Woodridge,
IL pharmacy location (or alternate company designated location) at
a minimum once per year and no more than two times annually for any
mandatory meeting and/or training.
--- Ability to complete I-9 work authorization in person preferably
at either a Symbria Rx pharmacy location or Symbria Rehab community
or may use a notary office as alternative.
--- Signed acknowledgement of Telecommuting Policy
--- Pharmacy data entry experience; minimum one year.
--- Strong knowledge of Brand/Generic drugs and medical
--- Experience with FrameworkLTC and Docutrack systems, minimum two
Technical qualifications (applicants must meet all technical
qualifications at time of application)
--- Standardized technology equipment provided by the company
- Desktop computer
- Two monitors
- Phone with teleworker license
- Display port cables
- Keyboard and mouse
--- Must have high-speed, internet access provided by a cable or
fiber provider (no DSL or satellite). Internet is not provided or
reimbursed by Symbria.
- Users with no more than three (3) local devices connected, a
minimum connection speed 25 Mbps for downloads, and 5 Mbps for
uploads is required.
- Users with four (4) or more devices such as laptops/ computers,
mobile phones/ tablets, VOIP home phone, gaming systems, and
streaming video systems (Netflix, Amazon Fire/ TV, Google, Roku,
Apple TV, etc.), the minimum connection speed required should be 75
Mbps for downloads and 5-10 Mbps for uploads.
- We recommend a wire connection to your home internet router. Slow
or poor internet connection may impact or prohibit the ability to
perform your job. The use of Wi-Fi 'air cards' (mobile hot spots)
- Symbria reserves the right to verify that your system will meet
or exceed these requirements.
Why work at Symbria?
--- 100% employee-owned company through an Employee Stock Ownership
Plan, also known as an ESOP. You, along with your co-workers, have
an ownership stake in this company!
--- Competitive compensation
--- ESOP retirement plan
--- 401(k) & Roth 401(k) plans
--- Employee Assistance Program
--- Full-time employees are eligible for medical, dental, vision,
life insurance, short/long term disability, flexible spending
accounts (FSA), Paid Time Off (PTO) + 6 Holidays and Yearly Tuition
Keywords: Symbria, Dayton , Pharmacy Data Entry/Adjudicator, Healthcare , Dayton, Ohio
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