OrthoCincy is an orthopaedic surgery and sports medicine physician practice that offers complete orthopaedic and sports medicine care at 13 convenient office locations across Greater Cincinnati and Northern Kentucky. The practice consists of 45 board-certified/eligible physicians specializing in general orthopaedics and a variety of sub-specialties, and offer in-office X-ray, MRI, and physical therapy services. 

The Edgewood and Eastgate locations feature an Orthopaedic Urgent Care that is designed to treat urgent orthopaedic injuries and conditions without an appointment.  The Orthopaedic Urgent Care is open Mon-Fri 9am-9pm, and Sat 9am-1pm.  No appointment is required, and Walk-Ins are welcome.  A visit to the Orthopaedic Urgent Care  costs less than an ER visit.

Industry: Medical Practices
Company Size: 201-500 employees

OrthoCincy

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**Description**

**Job Supervisory Responsibilities: ** May direct the clinical support staff with direct patient care.

**General Summary: ** Responsible for practicing orthopaedic medicine with or without physician medical supervision.

**Essential Job Responsibilities**

~~**Minimum of two years orthopaedic experience required.** ~~

- Performing comprehensive and problem focused history and physical exams.

- Interpret and correlate laboratory and diagnostic procedures, subjective and objective data to formulate a differential diagnose and establish a working diagnosis.

- Formulate a treatment plan for Orthopaedic problems within scope of practice.

- Implement therapeutic intervention for specific conditions when appropriate.

- Exercise judgment on problems requiring consultation, referral, or evaluation by the supervising Orthopaedic surgeon or other health care professionals.

- Order, collect, and perform appropriate laboratory or diagnostic procedures, and studies including but not limited to blood and tissue specimens. Ordering or performing diagnostic studies such as but not limited to EMG, electrocardiogram, compartment pressure measurements, and x-ray examinations including special x-ray examinations CT, MRI, and bone scans etc.

- Performing procedures such as but not limited to, digital blocks, regional anesthesia, and minor outpatient surgical procedures such as but not limited to: tendon repair, wound closure, wound management, wound debridement, incision and drainage, needle biopsy, percutaneous pinning of fracture, k-wire removal and hardware removal.

- Perform diagnostic and therapeutic procedures including but not limited to joint and bursa aspirations, closed reduction of fractures and dislocations, injections of joints, tendons, trigger points and bursa, as well as brace, cast, and splint applications.

- May assist in surgery to include but not limited to first assist, deep and superficial tissue closures, application of appliances and any other action delegated by the surgeon.

- May conduct hospital rounds, write orders, and take call for the Orthopaedic surgeon. Evaluate and clarify clinical conditions, formulate and implement a treatment or therapeutic plan for hospitalized patients, dictate discharge summaries, histories and physicals.

- Order, prescribe, dispense, and administer medication, orthosis, orthotics, braces, and other Orthopaedic devices.

- Evaluate, screen, and counsel patients on health maintenance and promote utilization of community resources. Design, conduct and/or participate in the research studies, manage databases, and perform quality assurance.

- Participates in peer reviews, chart reviews, staff education, clinical guideline development, and other continuing education and quality assurance activities to demonstrate compliance with standards, regulations, policies, and procedures. Complies with confidentiality requirements. Promotes patient advocacy.

- Collaborates with physicians in managing acute and long-term medical needs of the patient. Provides monitoring and continuity of care between visits according to treatment plan.

- Availability to take on-call responsibilities as needed and will act as a consultant/collaborator to clinical team on orthopedic area of specialty.

- Establish and maintain effective working relationships with patients, providers, co-workers, and the public.

- Uses customer service principles and techniques to deal with patients calmly and pleasantly.

- Follows OSHA, HIPAA and safety guidelines and regulations.

- Ensure licensures are current and up to date.

- 20. Perform other duties necessary or in the best interest of the department/organization.

**Requirements**

**Education/Experience:**

- Minimum of two years prior orthopaedic experience.

- Bachelor’s degree and successful completion of accredited physician assistant program.

- National certification from the National Commission on Certification of PAs.

- Current Kentucky state license.

- Current CPR certification.

**Other Requirements: ** Travel to satellite location and hospitals as necessary. Schedules will change as department needs change, including evenings and weekends.

**Knowledge**

**Performance Requirements:**

- Knowledge of health care field and medical office protocols/procedures.

- Knowledge of specific assisting tasks related to particular medical practice.

- Knowledge of information that must be conveyed to patients and families.

- Knowledge of electronic health record systems.

**Skills**

- Skill in caring for patients.

- Skill in tact and diplomacy in interpersonal interactions.

- Skill in understanding patient education needs by effectively sharing information with patients and families.

**Abilities**

- Ability to learn and retain information regarding patient care procedures.

- Ability to project a pleasant and professional image.

- Ability to plan, prioritize, and complete delegated tasks.

- Ability to demonstrate compassion and caring in dealing with others.

Equipment Operated: Standard medical/office equipment

Work Environment: Combination of medical office and exam/procedure room settings.

Mental/Physical Requirements: 80% of the time standing. Must be able to use appropriate body mechanics techniques when making necessary patient transfers and helping patients with walking, dressing, etc. Must be able to lift up to 50 pounds.

Physician Assistant

Onco360 is one of the largest independent providers of Oncology Pharmacy services in the country.  The company was founded in 2003 to bring together the stakeholders involved in the cancer treatment process and serve the specialized needs of oncologists, patients, hospitals, cancer centers of excellence, manufacturers, health plans, and payers.   

The company’s clinical and dispensing model was developed specifically to meet the unique needs of oncology-treating physicians and their patients. 

In its focus to bring together the stakeholders involved in the cancer treatment process, Onco360 is advancing the continuum of oncology pharmaceutical care through patient advocacy, dispensing excellence, and the clinical experience and expertise that comes from its focus in oncology.  

Onco360 is headquartered in Louisville, KY and dispenses nationally through its network URAC-, ACHC- and JCAHO-accredited Oncology Pharmacies.

Industry: Pharmaceutical Manufacturing
Company Size: 501-1,000 employees

Onco360 Oncology Pharmacy

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in **Louisville, KY. ** This will be a Full-Time position. **This position must be located within driving distance to our pharmacy, with a hybrid work style.**

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

**Starting salary from $21.00 an hour and up**

We offer a variety of benefits including:

- Medical; Dental; Vision

- 401k with a match

- Paid Time Off and Paid Holidays

- Tuition Reimbursement

- Company paid benefits - life; and short and long-term disability

**Pharmacy Adjudication ****Specialist Major Responsibilities:**

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections

Pharmacy Adjudication Specialists at Onco360...

- Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.

- Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..

- Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.

- Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.

- Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays

- Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)

- Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.

- Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.

- Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.

- Document and submit requests for Patient Refunds when appropriate.

Pharmacy Adjudication Specialist Qualifications and Responsibilities...

- Education/Learning ExperienceRequired: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims AdjudicationDesired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience

- Work ExperienceRequired: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experienceDesired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience

- Skills/KnowledgeRequired: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skillsDesired: Knowledge of Foundation Funding, Specialty pharmacy experience

- Licenses/Certifications Required: Registration with Board of Pharmacy as required by state lawDesired: Certified Pharmacy Technician (PTCB)

- Behavior CompetenciesRequired: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

**#Company Values: Teamwork, Respect, Integrity, Passion**

#IH

Pharmacy Adjudication Specialist

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