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Pharmacy Technician - Claims Initiation
About this job
Position Summary
Omnicare, Inc. is a wholly ownedsubsidiary of CVS Health Corporation. www.cvshealth.com
What We Do
Directly, and through oursubsidiaries, Omnicare provides a broad array of pharmacy-related services tolong term care facilities and to other customers in the health careenvironment. While senior care has long been an Omnicare specialty, we alsoserve other targeted populations.
Overview: The CIC, Claims associate is responsible for the timely and accurate distribution of phone calls and documents, as well as document storage throughout the CIC. Claims associates will research prior authorization (PA) requirements, gather all PA information needed, and complete the PA procedure in a timely manner. Are required to work with CIC staff, pharmacy staff, nursing facility staff and physician offices to ensure timely payment of online submission of claims and responsible for follow-up on all prior authorizations that have been submitted to the insurer for review.
Shift: 10A - 6:30P, Monday - Friday; including every 5th weekend. Plus one major holiday per year.
Key Responsibilities:
Triage all incoming phone calls and faxes Scan, file and electronically store all prior authorizations and other CIC related documentation Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists Work with local pharmacies to meet run times and ensure timely dispensing of medications Work with facility staff to gather pertinent information needed to secure overrides/prior authorizations Initiate Prior Authorizations as directed by a CIC pharmacist or Clinical Specialist Fax and electronically submit completed prior authorizations to insurance plans for review Call insurance plans to follow-up on submitted prior authorizations Communicate to the Supervisor staff and then escalate to the Claims Manager any changes in prior authorization criteria or issues related with various insurance plans and processors Work backlog of rejects as appropriate Follow all applicable government regulations including HIPAA Display behavior which exemplifies employee code of conduct guidelines.
Position Summary
Omnicare, Inc. is a wholly ownedsubsidiary of CVS Health Corporation. www.cvshealth.com
What We Do
Directly, and through oursubsidiaries, Omnicare provides a broad array of pharmacy-related services tolong term care facilities and to other customers in the health careenvironment. While senior care has long been an Omnicare specialty, we alsoserve other targeted populations.
Overview: The CIC, Claims associate is responsible for the timely and accurate distribution of phone calls and documents, as well as document storage throughout the CIC. Claims associates will research prior authorization (PA) requirements, gather all PA information needed, and complete the PA procedure in a timely manner. Are required to work with CIC staff, pharmacy staff, nursing facility staff and physician offices to ensure timely payment of online submission of claims and responsible for follow-up on all prior authorizations that have been submitted to the insurer for review.
Shift: 10A - 6:30P, Monday - Friday; including every 5th weekend. Plus one major holiday per year.
Key Responsibilities:
Triage all incoming phone calls and faxes Scan, file and electronically store all prior authorizations and other CIC related documentation Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists Work with local pharmacies to meet run times and ensure timely dispensing of medications Work with facility staff to gather pertinent information needed to secure overrides/prior authorizations Initiate Prior Authorizations as directed by a CIC pharmacist or Clinical Specialist Fax and electronically submit completed prior authorizations to insurance plans for review Call insurance plans to follow-up on submitted prior authorizations Communicate to the Supervisor staff and then escalate to the Claims Manager any changes in prior authorization criteria or issues related with various insurance plans and processors Work backlog of rejects as appropriate Follow all applicable government regulations including HIPAA Display behavior which exemplifies employee code of conduct guidelines.
Preferred Qualifications
- Minimum of 6 months to one year full-time
- Pharmacy experience Certified Pharmacy Technician
Required Qualifications
- Registered as a Pharmacy Technician in the state of Illinois
- Must be proficient in data entry and Microsoft Office programs
- Strong verbal and written communication skills and the ability to work effectively cross-functionally with all levels.