Pharmacy Technician - Billing Specialist

About the role

Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month-end billing functions, procedures and reporting. Provides excellent customer service to patients, caregivers, medical providers and insurance carriers.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Reverify benefit coverage criteria as needed for claims follow up.
• Accurately enters and/or updates patient/insurance information into billing system.
• Maintain and continually audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance.
• Accurately enter patient information into the pharmacy system.
• Provide assistance and timely response to all billing customer inquiries via phone or electronic communications.
• Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money.
• Process patient payments, returns, and credits.
• Transmit individual credit card payments as needed.
• Pursue payment from delinquent accounts and make payment arrangements.
• Research, identify and organize requested audit documentation in timely manner.
• Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed.
• Make corrections as needed and rebill claims as necessary.
• Develop knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances).
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements.
• Rotate through other departments to gain working/functional knowledge of other department workflows.
• Follow all applicable government regulations including HIPAA.
• Work as a collaborative team member to meet the service goals of the pharmacy.

Requirements

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy.
• Relational – ability to build relationships with business unit management and become “trusted advisor.”
• Strategy and Planning – ability to think ahead, plan and manage time efficiently.
• Problem Solving – ability to analyze causes and solve problems at functional level.
• Team Oriented – ability to work effectively and collaboratively with all team members.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).

Skills

• 1+ years of related experience.
• Advanced computer skills; pharmacy information system experience preferred.
• Ability to work independently and deliver to deadlines.
• Great attention to detail and accuracy.
• Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines.
• Quality minded; motivated to seek out errors and inquire about inaccuracies.

Benefits

What We Offer

1. Compensation & Financial
   
   1. Competitive pay
      
   2. 401(k) with company match
      
2. Family, Health & Insurance Benefits
   
   1. Medical
      
   2. Dental and Vision
      
   3. Health Savings Accounts and Flexible Spending Accounts
      
   4. Company-paid Basic Life and Accidental Death & Dismemberment
      
   5. Company-paid Long-Term Disability and optional Short-Term Disability
      
   6. Dependent Care Flexible Spending Accounts
      
   7. Wellbeing Employee Assistance Program (EAP)
      
   8. Guardian Angels (Employee assistance fund)
      
   9. Time Off
      
      1. Paid holidays and sick days
         
      2. Generous vacation benefits based on years of service

   Pay

   Compensation & Financial
   

   1. Competitive pay

   Schedule

   Flexible hours.