TruHealth
Location (3)
Atlanta, Georgia
Locations
The technician will manage daily pharmacy claims activities, including reviewing point-of-service claims, resolving rejections and payment discrepancies, and ensuring accurate claim adjudication through collaboration with external teams. Key duties also involve facilitating the prior authorization process and serving as the primary billing contact for network pharmacies.
Candidates must have a high school diploma or equivalent and a minimum of two years of experience as a Pharmacy Technician, in long-term care, or within a health plan setting, specifically involving pharmacy claims, rejections, and prior authorizations. Proficiency in Microsoft Suite applications and strong analytical and communication skills are required, along with adherence to CMS regulations.
The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan’s Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).
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