Adjudication Supervisor

Description:

The Supervisor, Adjudication supports the accurate and timely adjudication and billing of prescriptions by overseeing daily workflow, monitoring productivity, and serving as a technical resource to the adjudication team. The role helps ensure prescription rejections, payer changes, billing issues, and related work are completed accurately and on time. The Supervisor partners with the Adjudication Manager to support workflow execution, training, process consistency, and department performance.

Job Responsibilities

• Oversee daily adjudication workflow and help ensure prescription rejections and billing issues are addressed accurately and timely.
• Monitor workflow, productivity, and department priorities and partner with the Adjudication Manager to address gaps or changing business needs.
• Help ensure billing cut-offs and operational deadlines are met to support timely prescription processing and deliveries.
• Support implementation of new procedures, policies, and workflow changes and monitor consistent execution.
• Coordinate staffing coverage and recommend schedule adjustments based on workflow, business needs, and approved time off.
• Support payroll and timekeeping activities as assigned.
• Identify performance, attendance, workflow, or conduct concerns and escalate them to the Adjudication Manager for appropriate follow-up.
• Train and support technicians and help maintain current training materials, procedures, and job resources.
• Serve as a technical and workflow resource to team members and assist with resolution of more complex adjudication or billing issues.
• Support effective coordination between adjudication and other pharmacy or operational teams.
• Identify workflow and process improvement opportunities and recommend solutions to department leadership.
• Maintain accurate documentation and support consistent billing practices.
• Perform other activities assigned by leadership.

Requirements:

Basic Qualifications

• High School Diploma or GED and 1–3 years of data entry, pharmacy billing, adjudication, or related experience, or an equivalent combination of education and experience.
• Working knowledge of prescription adjudication, billing, data entry, or related pharmacy processes.
• Intermediate computer proficiency and ability to use pharmacy and medication distribution software.
• Ability to organize and coordinate workflow, manage competing priorities, and support timely completion of department requirements.
• Strong communication, problem-solving, attention to detail, and organizational skills.
• Ability to read and interpret medication documentation, business correspondence, procedures, reports, and related information.
• Ability to perform basic mathematical calculations and understand rates, percentages, reports, charts, and operational data.

Preferred Qualifications

• Long-term care pharmacy experience.
• PTCB certification.
• Experience with pharmacy or medication distribution systems such as EMAR, Pyxis MedBank, Frameworks, or comparable systems.
• Experience training, guiding, or serving as a workflow resource to other team members.

Compensation: $40,000-$60,000