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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims billing and prior authorization processes, ensuring accuracy and compliance with HIPAA guidelines. Possesses strong customer service skills and the ability to manage multiple tasks in a high-pressure environment.
Highest-signal resume keywords
Certified Pharmacy TechnicianPrior Authorization ExperienceClaims ManagementCustomer Service ExcellenceHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims BillingClaims TroubleshootingReconciliation of ClaimsAdjudication ProcessesPatient Assistance Plans
Soft Skills
Effective CommunicationMulti-taskingIndependenceProfessionalismTime Management
Tools & Technologies
Office EquipmentComputer SystemsBilling Software
Certifications & Qualifications
Certified Pharmacy Technician (Colorado)Registered Pharmacy Technician (Florida)
Industry Keywords
Claims AdjudicationPatient AssistanceInsurance Information AccuracyHigh-Pace EnvironmentConfidentiality Guidelines
About the role
Key responsibilities & impact- Manage the adjudication inboxes
- Assist with medical claims billing
- Troubleshoot orders with rejected status, including refill too soon, dose changes, duplicate claims, and eligibility issues
- Reconcile the master claims queue
- Assist with billing projects, including Member AR report and COGS
- Ensure insurance information is accurate for correct adjudication
- Assist patients with re-enrollment of copay cards and patient assistance plans
- Communicate with patient assistance plans when necessary to obtain payment
- Assist with timely initiation and resolution of prior authorizations
- Work with appropriate staff members to resolve claims issues
- Follow and aid in enforcement of company policies and procedures
- Perform other duties as assigned
- Work in a typical office environment with prolonged sitting and standing in front of a computer
- Operate standard computer, phone, and office equipment
- May work long hours and handle occasional high-stress customer, client, and employee interactions
Requirements
What you’ll need- High School Diploma or equivalent
- Certified and Registered Pharmacy Technician, (Colorado) in good standing required
- Registered with the State of Florida (Florida techs only) in good standing required
- Certification preferred for Florida pharmacy technicians
- Previous Prior Authorization or Claims experience is preferred
- Demonstrates a high degree of personal responsibility regarding accuracy and quality of work
- Demonstrates ability to work effectively and maintain expected productivity
- Ensures accuracy of information being provided to Management for review
- Schedules own time based on priorities
- Demonstrates Excellent customer service and Professionalism
- Ability to multi-task
- Ability to communicate effectively, patiently, and courteously
- Ability to work in a high pace, stressful environment
- Should be independent and self-motivated
- Maintains a good attendance record
- Respect and maintain confidentiality guidelines of HIPAA