Pharmacy Technician - Billing Specialist

Compensation

$26 - $30 an hour

Schedule

Variable Schedule; pharmacy is open 8am - 8pm Monday - Sunday

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.
• Uses working knowledge to troubleshoot and resolve customer service issues.
• 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.
• Through prior experience and cross training, demonstrates knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs), and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions.
• Exercises 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 in a timely manner and with a high degree of accuracy.
• Consistently meets pharmacy's established accuracy and productivity levels.
• Follows all applicable government regulations including HIPAA.
• Works as a collaborative team member to meet the service goals of the pharmacy.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).
• 2 + years related experience including a minimum of 6 months billing experience in long term care or retail setting.
• Advanced computer skills; pharmacy information system experience required.
• 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.