Adjudicator - - Remote

Job Description:

Overview

Maxor is currently seeking an Adjudicator to join our Specialty pharmacy team. Support personnel duties within the service and fulfillment workflow for Maxor’s Specialty Pharmacy Division. These duties may or may not be required by the state board of pharmacy to be carried out by a technician. All job functions within each category listed below will follow the applicable state board of pharmacy rules and regulations related to support personnel/technician responsibilities of the state the pharmacy resides. Essential functions for each category are outlined below. Each individual employee will have the appropriate boxes checked that indicate what their responsibilities in the pharmacy will include. In some pharmacies, multiple boxes and duties will be assigned to a single individual.

Our Company

At Maxor, we are committed to the cost-effective delivery of impactful pharmacy & healthcare services to patients & clients. Our reputation has been earned by continuously leveraging our comprehensive capabilities through innovative solutions and cutting-edge technology that fuel the entire pharmacy ecosystem; delivering value to our clients & patients, both in their pharmacy spend and in positive health outcomes. Our company of 1,000 diverse people operates with transparent objectives, clear accountabilities, tenacity & passion to write the next chapter of Maxor’s long history of growth and success. But, we are more than pharmacy services. We enable pharmacy care.

Our Locations

The Maxor workforce brings robust experience, diverse perspectives and dedication from employees working all over the US in pharmacies, hospitals, home offices, or corporate offices. This Specialty Pharmacy location is in Amarillo, TX.

Responsibilities

ESSENTIAL FUNCTIONS APPLICABLE TO ALL ROLES/DUTIES:

(This document in no way states or implies that these are the only duties to be performed by the employee occupying this position)

1. Meets performance standards and expectations.
2. Follows all Company policies and procedures.
3. Assists with projects as necessary.
4. Assists other areas as needed.
5. Assists in compiling necessary reports and/or audit information as requested.
6. Works cooperatively with other staff members to promote a positive and team oriented work environment.
7. Assists in maintaining cleanliness and orderliness of the pharmacy.
8. Participates in the Performance Improvement/Quality Management Process.
9. Maintains accurate and complete patient records.
10. Participates in pharmacy orientation programs, training programs, pharmacy staff meetings, in-services, and other programs as required.
11. Exemplifies excellence in customer communications and service.
12. Meets performance standards and expectations.
13. Has a good understanding and working knowledge of all Maxor policies and procedures, accreditation requirements and HIPAA operational guidelines.
14. May be included in after hours on-call rotation.
15. Maintains regular attendance per established policies.
16. Perform other job-related duties as assigned

☐ Adjudicator Functions:

1. Responsible for all claims daily and ongoing in SPRX C
2. Works rejected claims in SPRX C
3. Accepts all payable claims in SPRX C
4. Reviews and accepts Margin claims in SPRX C
5. Process all credit card charges for refill patients
6. Verifies all patients were shipped daily or communicated to that are on the Refill Assessment Report
7. Answer incoming calls as assigned and as transferred
8. Responsible for the following ques in the SPRX list:
   • C- Claims to Adjudicate Refills

Qualifications

Education

• HS Diploma/GED required. Some college work preferred

Experience:

• Previous experience with patient accounts in a pharmacy or healthcare setting
• Understanding of insurance, prior authorization and patient benefits strongly preferred
• A minimum of one-year patient accounts experience mandatory
• Computer experience mandatory
• Ability to communicate effectively orally and in writing, to interact with a wide variety of individuals to successfully provide optimal patient care

Knowledge, Skills and Abilities

• Excellent verbal and written communications skills are a must
• Must have good mathematical skills and be able to calculate discounts and fees quickly
• Previous experience in coordinating patient care in an alternate site setting is a must
• Must be eligible for participation in all applicable State and Federal reimbursement programs. Cannot be excluded from participating in any of the programs
• Must have the ability to work well under pressure
• Must be self-motivated and be able to work without the absolute presence of a supervisor
• Must posses an analytical or problem solving thought process
• Must be confident, assertive, reliable, self-motivated, trustworthy, and sincere

WHY CHOOSE A CAREER AT MAXOR?

Did you know that patients see their pharmacist an average of 12 times a year? Pharmacy is at the heart of healthcare. Come join Maxor and make a direct impact on patients’ lives. Improve your own wellbeing with our robust benefits and flexible work environment. At Maxor, you have a career with limitless possibilities and the charge to make a difference. A company of 1,000 diverse people and almost 100 years of pharmacy experience, we offer the stability of a Fortune 500 company with the energy and innovation of a startup. We provide services and technology that fuel the entire pharmacy ecosystem, but we are more than pharmacy services. We enable pharmacy care.

WE OFFER: A diverse, progressive culture that supports a “dress for your day” attire and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
• Company paid basic life/AD&D, Short-term and Long-term disability insurance
• Rx, dental, vision, short-term disability, and FSA
• Employer-matched 401k Plan
• Industry leading PTO plan
• And MORE!

Apply today at: https://careers-maxor.icims.com/

Maxor is an EOE, including disability/vets