Pharmacy Medical Billing Revenue Cycle Representative (Hybrid) Offsite

Position And Application Details

In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” to the submission:

• Resume
• Cover Letter

Responsibilities

Medication Access Support: Assist patients and staff with benefits investigation and prior authorization completion for medication therapies billed to the medical benefit. Communicate with patients, pharmacists and/or providers to gather required information. Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements. Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations. Track authorization requests and follow up with payors to ensure timely determination. Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable. Assist with copay/coinsurance assistance when applicable. Monitor authorization expiration dates and obtain renewals for ongoing therapies. Maintain accurate documentation of all authorizations within the electronic health record. Communicate with patients, insurance companies, prior authorization and to assist with resolution of patient account inquiries. Appeal/troubleshoot claim payments and/or denials using available resources. Participate in process improvement and workflow optimization initiatives aimed at reducing authorization delays and improving patient access to care. Assist the pharmacy coding and billing team with the resolution of claims issues. Provide accurate documentation of all activities as required by accrediting agencies, payers and/or administration. Monitor reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations. Adhere to compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations. Provide the highest customer service experience for patients and providers.

Operations and Performance Standards

• Utilize tools and processes to maximize the efficiency of the revenue cycle. Resolve pharmacy billing discrepancies and identify possible trends. Identify areas to improve the billing process. Identify areas to improve the benefits investigation and prior authorization process.
• Comply with established cash handling policies and procedures of the institution and department. Assist with the evaluation and implementation of new products/technology. Assist with the evaluation and implementation of new policies and procedures. Participate in standard pharmacy operations as the need arises.

Reporting

• Analyze, identify, and report trends found during workflow or as assigned. Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner. Report discrepancies found during analysis. Document activities required by accrediting agencies, payors and/or administration (i.e. workload statistics, phone statistics, etc.).

Communication/Training

• Communicate with providers, payors, patients, co-workers, supervisors and departments to resolve revenue cycle issues. Understand the importance of effective business communication and maintaining professionalism in difficult situations. Participate in orientation of pharmacy technicians, pharmacists, pharmacy residents and others within the department on medical billing practices for medications. Complete and maintain compliance with all competencies and educational requirements.

Education Requirements

Completion of a Bachelor’s degree or equivalent combination of education and experience. Successful completion of the pharmacy technician certification exam within twelve months of the start of employment.

Experience Requirements

• Previous experience in customer service.
• Experience and proficiency with computer software applications (i.e. Microsoft Office Suite – Word, Excel, Outlook, PowerPoint) or comparable programs.
• Strong attention to detail and proven ability to gather and analyze data and keep accurate records.
• Self-motivated with initiative to seek out additional responsibilities and tasks along with generating suggestions for improving workflow.
• Effective verbal and written communication skills, active listening skills and the ability to maintain professionalism while handling difficult situations.
• Demonstrate effective problem solving abilities and meets challenges with resourcefulness.
• Familiarity with medical terminology.

Desired Qualifications

• Experience working in a complex hospital system is highly desirable.
• Medical medication management experience is highly desirable.
• Medical billing experience is highly desirable.
• Experience working in a collaborative team environment is desirable.
• Pharmacy experience is desirable.
• Knowledge of healthcare billing and prior authorization process, experience working with insurance and/or federal and state assistance programs is desirable.
• Experience working with multiple technology platforms (i.e. Epic, GE) is desirable.
• Knowledge and understanding of the Health Insurance Portability and Accountability Act (HIPAA) is desirable.