Billing Coordinator - Specialty Pharmacy

Essential Duties & Responsibilities

• Manages the adjudication inboxes
• Affords support with medical claims billing
• Handles troubleshooting orders with a rejected status; refill too soon, increase/decrease of dose, duplicate claim, and eligibility issues
• Ensures the reconciliation of the master claims queue
• Affords support with billing projects, such as Member AR report, COGS, etc.
• Ensures insurance information is accurate for correct adjudication
• Affords support with the timely initiation and resolution of prior authorizations
• Works with appropriate staff members to resolve claims issues
• Affords support in enforcing all company policies and procedures
• Respects and maintains confidentiality guidelines of HIPAA
• Performs other duties as assigned

Education and Experience

• 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
• Previous Prior Authorization or Claims experience is preferred

Knowledge, Skills, and Abilities

• 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