Pharmacy Billing Specialist

Primary Responsibilities:

• Consults with patients to resolve all types of payer and coverage issues.

• Contacts the patient, when necessary, to gather insurance and billing information or notify of a delay in processing.

• Conducts a benefits investigation, updates patient accounts, prescriptions, etc.

• Collects outstanding patient balances.

• Processes adjudication rejections, insurance terminations, and insurance changes.

• Handles patient benefit statement questions to a conclusion.

• Researches and reviews patient inquiries on account balances.

• Knows Amber HIPAA policies and maintains patient confidentiality at all times.

• Works as a team member with all other departments to verify benefits.

• Working knowledge of all necessary computer software to perform job duties.

• Bill claims via electronic NCPDP clearinghouse; cross-trains in Medical billing as time allows.

• Works claims in the clearinghouse to ensure our payers receive them.

• Responsible for aiding in accounts receivable by billing claims correctly and getting them to our payers on time.

• Works with team to achieve Company AR goals.

• Understanding of payer contracts and how claims should be submitted to each payer.

• Has mastered the requirements of a Pharmacy Billing Specialist so they can train new hires on company policies and procedures, including HIPPA policies.

• Gather and evaluate information from employees and management on previous training to identify strengths, weaknesses, and areas that need improvement.

• Inform employees on scheduled training and track their progress.

• Instruct employees to complete a benefits investigation and update patient accounts, prescriptions, etc.

• Trains new hires and teams on adjudicating rejections, insurance terminations, and insurance changes.

• Educates new hires and the team on how to review statements and patient balances.

• Trains new hires and teams on computer software and programs to perform job duties.

• Teaches new hires and team the difference between medical and NCPDP billing.

• Assists in developing SOP and training documents to perform job duties.

• Monitors new hires and teams on their progress and ensures how to perform job duties.

• Assist the Lead Pharmacy Billing Specialist in training needs; document the employee training.

Professional Competencies:

• Proficient with MS Excel, Word, and Outlook.

• Strong oral, written, organizational and interpersonal skills.

• Ability to work in a team and with all levels of internal management, staff, outside clients, and vendors.

• Demonstrated ability to meet tight deadlines.

Required Qualifications:

• Working knowledge of the healthcare industry, specifically the pharmacy industry.

• One (1) year of experience billing electronic insurance claims, including; Medicaid, Medicare, and Commercial insurance via NCPDP clearinghouse.

• Experience working with clearinghouses for claim adjudication.

Educational Requirements:

High school diploma or equivalent.

Physical Requirements:

• Must remain stationary up to 90% of the time

• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and traverse conferences, meetings, and remote events.

• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

• The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

• The ability to observe details at close range (within a few feet of the observer).

Working Conditions: