Pharmacy Technician - Billing Specialist

Compensation

$21 - 24/hour

Responsibilities

• Processes customer bills and insurance claims in an accurate and timely manner.
• Assists with all daily and month-end billing functions, procedures, and reporting.
• Provides excellent customer service to patients, caregivers, medical providers, and insurance carriers.
• Researches and establishes patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Reverifies benefit coverage criteria as needed for claims follow-up.
• Accurately enters and/or updates patient/insurance information into billing system.
• Maintains and continually audits patient files and corresponding documentation necessary to defend third-party audits and ensure payer and company compliance.
• Accurately enters patient information into the pharmacy system.
• Provides assistance and timely response to all billing customer inquiries via phone or electronic communications.
• Researches and resolves patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Provides guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods.
• Proactively reviews patient profiles, drug regimens, and insurance coverage to evaluate options to save resident money.
• Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned.
• Processes patient payments, returns, and credits.
• Transmits individual credit card payments as needed.
• Makes payment arrangements for delinquent accounts.
• Researches, identifies, and organizes requested audit documentation in a timely manner.
• Performs prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations, or other issues as needed.
• Makes corrections as needed and rebills claims as necessary.
• Develops knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs), and Third-Party Insurances).
• Develops proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements.
• This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions.
• Rotates through other departments to gain working/functional knowledge of other department workflows.
• Follows all applicable government regulations including HIPAA.
• Works 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).
• 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.

Skills

• 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.