Pharmacy Adjudication Technician

Overview

Presbyterian Homes & Service sis seeking a Pharmacy Adjudication Technician to join its Radius Living Rx team.

The Pharmacy Adjudication Technician supports accurate and timely reimbursement for medications and services provided to long-term care facilities and their residents. This position reviews, analyzes, and processes insurance claims; resolves discrepancies, rejections, and denials; and works with insurance companies, healthcare providers, facilities, and internal teams so that billing issues do not delay medication delivery to residents. The Pharmacy Adjudication Technician reports to the Billing Manager.

Radius Living Rx is a long-term care pharmacy serving residents in partner communities across Minnesota and Wisconsin. Our pharmacists, technicians, and support staff work closely with facility care teams and prescribers, so the work stays close to the people it's for. We're building a team that wants pharmacy practice grounded in that relationship: careful medication management, direct communication with facility staff, and a genuine stake in how residents are doing.

• Review, analyze, and process insurance claims for medications and services provided to long-term care facilities and their residents.
• Address and resolve discrepancies, rejections, or denials of claims. Work with insurance companies, healthcare providers, and internal teams to ensure timely and accurate payments.
• Maintain accurate records of claims processing, denials, adjustments, and correspondence with insurance carriers, facilities, and patients.
• Ensure that all insurance adjudication processes comply with state and federal regulations, as well as pharmacy policies.
• Communicate with insurance companies, other pharmacy teams, and healthcare professionals to resolve issues related to claims, billing, and reimbursement. Address any lingering issues that may be holding up medication delivery to residents, and provide timely updates and transparent communication to facilities and residents about delays or required actions.
• Provide cross-functional support to other billing operations, including claims processing, prior authorizations, billing functions, and other administrative or revenue cycle responsibilities as workload demands.
• Assist with special projects, process improvements, system enhancements, and other duties assigned by the Billing Manager.
• Provide support to healthcare providers, pharmacies, and patients regarding insurance coverage, claims status, and payment issues.

Required:

• High school diploma or equivalent.
• Prior experience in pharmacy or medical claims adjudication.
• Excellent verbal and written communication skills, strong listening skills, and strong interpersonal skills to work effectively with other healthcare professionals.
• Demonstrated ability to work with a high degree of accuracy and attention to detail and to handle multiple tasks simultaneously, prioritizing appropriately.
• Desire and willingness to learn and perform new tasks.
• Self-motivation and self-direction.
• Demonstrated compatibility with PHS's mission and operating philosophies.
• Demonstrated ability to read, write, speak, and understand the English language to communicate with all customers.

Preferred:

• Active Minnesota Pharmacy Technician registration.
• Prior experience in long-term care (LTC) pharmacy.
• Prior experience with FrameworkLTC.

The estimated starting pay range for this role is $23.32 - $25.65 per hour. This good faith estimate is based upon PHS’s typical starting pay range for this role. Actual pay range depends upon many factors including each individual employee’s qualifications and market conditions and is subject to change.

Full-time benefits-eligible employment begins at a minimum of 30 hours per week:

• Health, and dental, including applicable HSA & FSA
• Employer Contribution to HSA for eligible Health Plans
• Life insurance (AD&D)
• Retirement, with eligibility for an employer match
• Holiday pay and extended sick

Full and Part-time benefits-eligible employment working between 20-29 hours per week:

• Vision insurance
• Voluntary short-term & long-term disability
• Accident & hospitalization coverage
• Education assistance programs

All employees:

• Accrue PTO (Paid time off)
• Same-day pay
• Employee assistance program (EAP)
• College partnership educational discounts
• Access to Learn to Live Resources

Presbyterian Homes & Services (PHS), based in St. Paul, Minnesota, is a nonprofit, faith-based organizationprovidinga broad array of high-quality…