Regional Billing Specialist

Regional Billing Specialist

About the role

Works directly with the Regional Billing Lead and Regional Billing Manager to execute various billing tasks for each of the pharmacy locations. Assists in audit compliance, vaccine billing, Medicare open enrollment, ancillary billing charges, cost comparisons and other billing-related tasks.

Responsibilities

• Assist in researching, identifying and organizing documentation related to the timely processing of PBM audit requests for all SPS locations
• Audit compliance
• Vaccine billing
• Medicare open enrollment
• Ancillary billing charges
• Create ancillary revenue billing transactions according to contract and pharmacy performance at required intervals (monthly, quarterly, etc..)
• Monitor and execute all billing-related functions surrounding vaccine clinics
• Participate in special enrollment and open enrollment activities as needed
• Provide customer service to internal and external customers as needed
• Update and process low income subsidies as needed
• Perform new admission medication cost reviews as needed
• Perform any other responsibilities as directed by supervisor

Requirements

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Strategy and Planning – ability to think ahead, plan and manage time efficiently
• Problem Solving – ability to analyze causes and solve problems at both a strategic and functional level with minimal direction
• Team Oriented – ability to work effectively and collaboratively with all team members
• Detail Oriented – ability to provide attention to detail
• Organizational – ability to organize work around multiple priorities and deadlines

Qualifications

• High School diploma required, college degree in business preferred
• Pharmacy Technician registration required; National Certification preferred (PTCB)

Skills and Qualifications

• Excellent computer skills, including MS Office (Excel, Word, Teams)
• Excellent verbal and written communication skills; professional demeanor
• Strong attention to detail and analysis skills
• Ability to maintain confidentiality at all levels
• Ability to work to deadlines and balance multiple priorities
• Strong work ethic and desire to excel
• Pharmacy experience required
• Collections and Adjudication experience preferred
• FrameworkLTC and FrameworkECM experience required
• Strong knowledge of 3rd party insurance requirements
• Strong knowledge of pharmacy documentation requirements preferred

Work Environment

• Ability to work flexible hours

What We Offer

• Compensation & Financial
• 401(k) with company match
• Family, Health & Insurance Benefits (Full-Time employees working 30+ hours/week only)
• Medical, Dental and Vision
• Health Savings Accounts and Flexible Spending Accounts
• Company-paid Basic Life and Accidental Death & Dismemberment
• Company-paid Long-Term Disability and optional Short-Term Disability
• Dependent Care Flexible Spending Accounts
• Wellbeing Employee Assistance Program (EAP)
• Guardian Angels (Employee assistance fund)
• Time Off
• Paid holidays and sick days
• Generous vacation benefits based on years of service