Adjudication Specialist

Job Description

Job Description

Adjudication Specialist

Position Summary

The adjudication specialist is responsible for ensuring that all client orders and customer orders are adjudicated accurately and efficiently according to a predetermined order of importance, as well as the order of importance set forth by the Pharmacist(s) on duty, or as delegated by the Lead Adjudicator. The adjudication specialist will work in all functions of the billing services department based on the needs of workflow for that day as delegated by the Lead Adjudicator or Pharmacist(s) on duty. The adjudication specialist will utilize computer hardware and software associated with In Touch Pharmaceuticals property, and any other tools needed to successfully complete their assigned tasks. The adjudication specialist will work as a part of a team to ensure that all the needs of the client and customer are met.

Job Responsibilities and Requirements

The primary purpose of the adjudication specialist is the contribution to a team effort to complete adjudication functions on all daily and monthly claims ensuring accuracy and efficiency to meet a predetermined deadline for processing. Routinely applies critical thinking skills and effectively initiates resolution to problems identified by the customer. The adjudication specialist may be required to sit for long periods of time, frequent movements of fingers and hands, and ability to maintain professionalism while handling outgoing and incoming calls from customers.

Essential Functions

The essential functions of the adjudication specialist position include : the adjudicating of all pharmacy prescription claims from clients and customers, complete daily adjudication process within the designated cut off times of each facility and adherence to company communication compliance practices.

• Customer Service

o Routinely applies telephone etiquette with peers and customers. Greeting, tone of communication and problem-solving concerns are professional.

o Routinely prioritizes daily adjudication based on workflow practices to meet processing deadlines.

o Prioritizes designated facilities to work through monthly adjudication processes to meet end of month deadlines.

o Pharmacy electronic software systems and tools

o Attendance at Department meetings

o Compliance with company handbook regulations (i.e. dress code, recording your time, conduct of behavior, etc.)

o Wears ID badge and enters time clock information as required.

o Personnel Payroll System

o Company electronic communication system(s)