Job Summary:
The Pharmacy Billing Specialist is responsible for performing tasks related to the onboarding, financial counseling, billing, posting, and denial/rejection management of all pharmacy patients managed by the RCM Company.
Duties/Responsibilities:
- Primary responsibility includes the performance of billing related functions as well as managing referrals and prior authorizations for pharmacy benefits
- Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities. Accurately enters and/or updates patient/insurance information into billing system.
- Provide benefits investigation results requested by the client pharmacies within 30 minutes of receipt.
- 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.
- Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues. Make corrections as needed and rebill claims as necessary.
- Follow all applicable government regulations
- Charge Entry/Billing -Responsible for accurate coding according to compliance guidelines, and for assigning and verifying ICD-9,ICD-10and CPT codes, based on provider documentation
- Post payments from insurance and patients. Reconcile daily.
- Call patients and collect co-pays and co-insurance for mail order prescriptions. Reconcile daily.
- Duties and responsibilities may change at any time with or without notice
- Physical presence at the office on a set and predictable schedule
Education and Experience:
- High school graduate or equivalent required
- Customer service experience
- Pharmacy Technician certification or equivalent experience in pharmacy billing
- Knowledge and understanding of pharmacy billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances)
- Knowledge of insurance benefits and pre-authorizations
Required Skills/Abilities:
- Exhibits enthusiasm, positive attitude, and professionalism in the workplace
- Ability to think ahead, plan, and manage time efficiently
- Works independently requesting assistance from supervisor as needed
- Advanced computer skills
- Great attention to detail and accuracy
- Quality minded; motivated to seek out errors and inquire about inaccuracies
- Ability to understand and troubleshoot the multiple complexities of pharmacy billing, and collecting
Physical/Mental Requirements:
The physical and mental requirements demands, and work environment described here are representative of those that must be met by an employee to successfully perform the primary duties and responsibilities of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary duties and responsibilities.
- Must be able to lift up to 25 lbs.
- Requires standing, walking, bending, kneeling, stooping, and crouching
- Perform repetitive motion activities
- Coordinate multiple tasks simultaneously
- Understand and respond to a diverse patient base