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JOB PURPOSE: Performs comprehensive pharmacy billing and collection processes, resolves real-time claim disputes and denials, and maintains account receivables. Responsible for seeking alternate resources for high cost drug reimbursements.
This position description may not include all of the listed duties, nor do all of the listed examples include all tasks which may be found or assigned to this position.
JOB DUTIES:
§ Gathers and verifies patient medication insurance information, including coverage types, insurance name and bank identification number (BIN), process control number (PCN), group number, and member number.
§ Establishes and maintains insurance files in the pharmacy point-of-sale system; assures accuracy of BIN, PCN, group numbers, and member numbers for related patient demographics and insurance files.
§ Monitors and tracks the pharmacy claims transmissions to insurance carriers and assures that claims are accepted and promptly resolves claims that are rejected; confirms the receipt of real-time claim adjudications.
§ Identifies the patient accounts requiring the coordination of benefits and processes all prior authorizations for patient prescriptions. Posts and reconciles payments from third party payors in a timely and efficient manner.
§ Maintains accurate patient accounts and makes adjustments as needed; adequately documents accounts.
§ Monitors pharmacy account receivables to assure timely receipt of payments for adjudicated claims.
§ Identifies high cost drugs and analyzes reimbursement limitations; identifies medication assistance programs available to offset cost.
§ Assists in identifying and preparing contracting documents to maximize third party reimbursements.
§ Works closely with pharmacists and coder to obtain information regarding diagnosis, medical documentation, other medications, or National Drug Code (NDC) numbers, etc., necessary for processing prescription claims.
§ Cross trains in Administrative Services units (HIM) for coverage during critical occurrences.
§ Ensures compliance with HIPAA regulations.
§ Maintains confidential information.
§ Performs other duties as assigned.
Job Type: Full-time
Pay: $22.73 - $30.69 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Education:
- High school or equivalent (Required)
Experience:
- Pharmacy technician: 1 year (Required)
- Pharmacy Billing: 1 year (Required)
License/Certification:
- Pharmacy Technician Certification (Required)
- Driver's License (Required)
Work Location: In person