Pharmacy Technician - Billing Specialist

About the role

Mullaney’s Pharmacy & Home Healthcare, a member of the Guardian family of pharmacies, is seeking a dedicated individual to join our team in Cincinnati, Ohio. We are a forward-thinking organization that redefines how pharmacy care is delivered, focusing on customized medication management solutions for healthcare organizations serving seniors and individuals with complex care needs.

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.
• Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned.
• Process patient payments, returns, and credits. Transmit individual credit card payments as needed.
• May 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.
• This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions.
• 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).
• 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

• 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

• Emotional well-being and physical health are important, which is why our employees receive a generous benefits package and a work culture that supports our core value of, “Treat others as you would like to be treated.”
• Compensation & Financial: Competitive pay, 401(k) with up to 3.5% company match (1), Family, Health & Insurance Benefits (1), (2), Multiple health plan options including copay (FSA-eligible) and HSA eligible plans, Wellness Incentive Program, Dental and Vision plans, Company-paid basic life, AD&D and long-term disability coverage, Optional employee, spouse, and child life/AD&D insurance, Optional accident, critical illness, and short-term disability coverage, Dependent Care Flexible Spending Accounts, Employee Assistance Program (EAP), Time Off: Paid holidays and sick days, Generous vacation benefits based on years of service.

What We Offer

• Emotional well-being and physical health are important, which is why our employees receive a generous benefits package and a work culture that supports our core value of, “Treat others as you would like to be treated.”
• Compensation & Financial: Competitive pay, 401(k) with up to 3.5% company match (1), Family, Health & Insurance Benefits (1), (2), Multiple health plan options including copay (FSA-eligible) and HSA eligible plans, Wellness Incentive Program, Dental and Vision plans, Company-paid basic life, AD&D and long-term disability coverage, Optional employee, spouse, and child life/AD&D insurance, Optional accident, critical illness, and short-term disability coverage, Dependent Care Flexible Spending Accounts, Employee Assistance Program (EAP), Time Off: Paid holidays and sick days, Generous vacation benefits based on years of service.