Aetna Specialty Pharmacy has openings for Veritechs / Pharmacy Techs in Orlando, Florida. Veritechs will be responsible for entering all new prescriptions and receiving appropriate reimbursement.
This will include, but is not limited to, the following activites:
Enter physician profiles in the computer systems. Enter insurance information into the patient profile. Interface with various departments as needed to coordinate activity, meet schedules and ensure acccuracy of all documents. Enter prescription orders into computer systems, verfiying accurate patient, physician, and insurance information, price codes, drugs, refill status, directions, days supply information. The Veritech will also communicate with the insurance carrier, patient, or physician when needed to ensure timely adjudication. Prints prescription labels and checks for accuracy before releasing to the pharmacist for approval.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
1. Ensure that individual, payor or company performance criteria are met or exceeded.
2. Interface with various departments and sister pharmacies as needed to coordinate activities and meet schedules.
3. Ensure accuracy of all input documents.
4. Handle and resolve all aspects of specialty insurances, including Medicare and Medicaid. Communicate with insurance carriers when necessary and advise patients or physician of results.
5. Input coding of insurance plans. Set up medical billing.
6. Communicate with patients on prescription benefits.
7. Process prescriptions according to company policy.
8. Create/update physician profiles in computer systems, demographics, DEA numbers, UPN codes.
9. Familiar with Medicare guidelines and processing procedures to ensure proper and timely payment.
10. Enter presciption orders into computer, verify patient, physician, insurance, price codes, drug, quantities, directions, and day's supply.
11. Resolve all insurance rejections to meet payor performance criteria. This includes Major Medical, PBM, PPO, IPA and HMO.
12. Identify, resolve, process and communiate full medical or pharmacy benefits.
13. Print rx labels, rti labels, verify accuracy.
14. If necessary, contact physician offices for refill authorization.
15. Report any nonconformity, errors, omissions, or incidents to proper supervisor or pharmacist.
16. Participate in staff meetings and help with any special projects.
17. Make suggestions to improve the workflow process.
18. Maintain processing productivity rates and error rates determined by management.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
Language Skills:
Ability to read and comprehend prescription instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Mathematical Skills:
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, percentages and decimals. Ability to compute rate, ratio, and days supply.
Reasoning Ability:
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills:
To perform this job successfully, an individual should have knowledge of HBS and SpClin pharmacy Order processing systems; Microsoft Office applications.
Certificates, Licenses, Registrations:
National Technician Certificate a plus.
Apply for this position. Please reference Job TFR-1189 in the additional notes section when applying.