POSITION TITLE: Pharmacy Billing Specialist
DEPARTMENT: Pharmacy
NATURE OF POSITION: The Pharmacy Billing Specialist is responsible for performing tasks related to the management of third-party billing for patients served by the Outpatient Pharmacies. Responsibilities include serving as a liaison between pharmacy billing operations, pharmacy staff, and pharmacy patients to ensure effective communication regarding billing issues.
MINIMUM QUALIFICATIONS:
High School graduate or equivalent required
Must be at least 18 years of age
Medical/Dental office experience preferred
Customer service experience required
Ability to work and communicate with a multidisciplinary healthcare team and the public
Basic computer skills required
Phone etiquette
Must be able to sit, stand, walk, bend, and/or lift for extended periods of time
RESPONSIBILITIES:
Review and screen patients to determine if patient has adequate prescription coverage. Refer appropriate patients to financial counseling for coverage or charity application.
Provide customer service via phone and triage patient calls to appropriate party.
Provide monthly adherence phone calls to patients.
Function as primary third party billing resource for Outpatient pharmacy staff.
Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carrier for all commercial, federal, and state insurance plans. Submit prior authorization requests, follow up on submitted prior authorization requests and submit claims with approvals as appropriate.
Identify patients who may qualify for patient medication assistance programs or copay assistance.
Contact payers for lost medication overrides, replacement, and vacation override approvals.
Assist with prescription audits.
Establish and maintain good working relationships with all billing operations specialists and other pharmacy staff members to maintain effective communication regarding third-party billing issues.
Assist in the development, implementation, and evaluation of third-party billing policies and procedures. Educate pharmacy staff about third-party billing policies and procedures as needed.
QUALIFICATIONS
Current certification and/or licensure as a Pharmacy Technician from the Oklahoma State Board of Pharmacy
High school education or GED certificate
PREFERRED
Previous experience working with medical cash applications, billing, medical collections, and/or accounts receivables
2+ years of experience working in Microsoft office, specifically Microsoft Excel (using filters, sorting, conditional formatting, and basic formulas), Microsoft Outlook, and Microsoft Word
National Certified Pharmacy Technician
ORGANIZATION:
Exhibits enthusiasm, a positive altitude, and professionalism in the workplace
Handles personal conflict and works through it at the lowest possible level (first with party/parties involved, then if necessary, with 3rd party mediation)
Is friendly and easy to approach
Is neat, clean, well-groomed, and dresses in accordance to the dress code policy
Leaves personal problems out of the workplace
Treats all co-workers with dignity and respect
Abstains from gossip in the workplace
Arrives on time and works through designated hours
Completes tasks effectively, accurately and on time
Demonstrates little or no absenteeism/follows leave guidelines
Follows designated line of support
Is flexible, able and willing to respond to unusual job-related demands
Manages time well
Recognizes and assists others in the work of the department, even though the work may be outside of regular duties
Shares equally in the workload of the department
Works cooperatively with all team members and departments
Works independently requesting assistance from supervisor only as needed
Abstains from criticizing COFMC, colleagues and supervisors
Demonstrates loyalty to COFMC, colleagues and supervisors
Demonstrates support of the mission and vision of COFMC
Accepts and participates in cross training
Takes initiative to identify skill development needs