Adjudication Specialist

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🔥 7 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Polaris Pharmacy Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2015

💼 Consulting

🏭 Manufacturing

📦 Logistics

Consulting • Manufacturing • Logistics

Polaris Pharmacy Services is a privately owned long-term and post-acute care pharmacy committed to delivering high-quality pharmacy services, exceptional customer experiences, and industry-leading value. Founded in 2015, Polaris is the 5th largest LTC pharmacy in the U. S. , operating 21 pharmacies across 29 states and serving over 80,000 residents. They provide innovative solutions in specialty pharmacy, pharmacy technology, packaging, reimbursement, workflow, and financial performance.

📋 Description

• Manage and identify a portfolio of rejected pharmacy claims • Review and evaluate insurance claims for insurer liability under policy provisions and state and federal regulations • Authenticate claimants and verify claim submission documents to prevent fraud and ensure compliance • Calculate benefit payments and approve claim settlements based on coverage and assessment findings • Coordinate with healthcare providers, repair services, and other parties to obtain documentation • Negotiate settlements for disputed claims • Monitor and resolve revenue risks involving payer setup, billing, rebilling, and reversals • Interpret and apply complex insurance policy language • Explain adjudication processes, claim denials, and settlement offers to claimants • Implement alternative dispute resolution methods when needed • Complete payer paperwork, prior authorization forms, and manual billing • Handle non-standard order entry situations • Support team training needs

🎯 Requirements

• High School diploma or equivalent required • Minimum of one (1) or more years working as a pharmacy technician in a retail environment required • Long-term care pharmacy experience preferred • Able to read, write, speak, and understand English • Able to retain and apply a large amount of information • Able to work in a fast-paced environment • Basic computer knowledge required • Basic math and analytical skills • Experience with alpha-numeric data entry • Proficient in Microsoft Word, Excel, and Outlook required • Customer service and results-oriented approach • Good organization and attention to detail • Reliable problem solver • Able to work various shifts and days • Adaptable to an ever-changing environment • Framework LTC, general computer knowledge, and 10-key number entry preferred • May sit or stand seven to ten hours per day • May work extended hours as needed • May lift and/or move up to 30 pounds

🏖️ Benefits

• Paid holidays: 6 days annually • 5 sick days annually • Up to 10 PTO days each year • PTO rollover options and milestone bonuses • Option to cash out up to 10 PTO hours each quarter • Medical, Dental, and Vision insurance • 401(k) (available for Part Time & Full Time EEs) • Company Paid Life insurance • Short-term and Long-term disability insurance • Tuition reimbursement • Competitive pay with annual performance reviews and merit-based raises • Career growth potential • Annual on-site voluntary Flu Vaccines • Employee referral bonus program