Pharmacy Billing Technician

Job Summary:

Primary responsibilities involve performing a full range of pharmaceutical billing technician duties including: the submission of properly executed pharmaceutical claims on a timely basis to third party payers and responsible parties by utilizing the RPMS Pharmacy Point of Sale system; and, rebilling or correcting billing of accounts previously submitted. Additional responsibilities include various clerical tasks and assisting pharmacy staff in the dispensing of prescribed medications, drugs, and other pharmaceuticals to provide the highest quality pharmaceutical care to Oyate Health Center (OHC) patients.

Essential Functions:

POS Billing Technician:

• Analyzes, maintains, and directs the operations for the pharmacy point-of-sale program.
• Edits and approves medical claims for the OHC on the Resource Patient Management System (RPMS).
• Researches and verifies patient insurance for Medicaid when encountering errors during edit of claims in RPMS.
• Completes insurance data for patient claims; processes, researches and corrects accounts; verifies diagnosis and authorization codes; identifies liability and guarantors; reviews and adjusts account balances; interprets Explanation of Benefits (EOBs); and, analyzes billing components.
• Prepares and submits electronic and paper claims to third party payers, intermediaries, and responsible parties according to established policy and procedures.
• Coordinates benefits, verifies data and secondary payer billing.
• Reviews all denied claims to determine if a claim was denied incorrectly based on the diagnosis, coding, Medicaid categories, and other erroneous denials; adequately follows up on denied claims and resubmits.
• Verifies the patient medical record contains proper documentation; provider signature, accuracy in dates of service; and, that primary care providers are in compliance with attestation and billing requirements.
• Maintains records and files in accordance applicable regulations and guidance. Ensures there is documentation of all action(s) taken for adequate audit trails. Provides documentation to the insurance companies when requested for an audit
• Answers questions from patients, staff, and insurance companies.
• Runs, maintains, and monitors POS reports, notifying participants of any trends or problems, notifies technicians of errors, and contacts third party providers when necessary.
• Answers all correspondence requesting additional provider or patient information.
• Notifies supervisor of all claims deemed unbillable along with reason(s) on a daily basis.
• Serves as a POS technical resource, provides orientation, and provides ongoing training and education to pharmacy staff.

Pharmacy Technician:

• Educates the patient about his/her medication regimen regarding number of refills, labeling instructions, insurance information, proper storage, and provides pre-printed medication pamphlets that reviews significant side effects of the medication when appropriate.
• Responsible for repackaging a variety of pharmaceuticals both unit-dose and pre-packaged medications, utilizing a variety of prepackaging equipment. Complete labels will be printed utilizing a variety of different labeling equipment. Affixes labels to bottles. Properly documents the repackaging in the pharmacy pre-pack log or the unit-dose re-pack log.
• Counts stock, monitors outdated medication, and enters data in computer to maintain inventory records.
• Generates pharmaceutical orders and validates submission, receive and stores incoming supplies, and provides medication replenishment in the automated pharmacy dispensing system.
• Stores medication in proper storage areas and rotates stock to ensure older stock is used first.
• Enters data such as patient name, prescribed medication and cost, to maintain pharmacy files, charge system, and inventory.
• Dispenses medications to patients at the front counter once the prescription and medication after verified by a pharmacist.

Additional duties:

• Answers the telephone and greets visitors and patients.
• Assists Pharmacy Supervisors in the maintenance of the RPMS Pharmacy Drug Files in the computer system for billing purposes, such as updating NDC numbers and “re-matching” drugs to the National Drug File (NDF) when necessary.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties as assigned.

Requirements

• Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work.
• Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations.
• Possess the ability to resolve issues with other departments and coworkers without direct supervision.
• Able to exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
• Ability to maintain a flexible work schedule, including evenings, weekends and overnight or extended travel as necessary.
• Ability to effectively present information in one-on-one and small group situations to community members, consumers and other employees of the organization.
• Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies.
• Valid driver’s license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations. "

Minimum Qualifications

Education/Relevant Experience: Completion of a formal training program or an associate’s degree and one (1) year of relevant experience; or a high school diploma or GED and three (3) years of relevant experience.

Active Certified Pharmacy Technician (CPhT) License through PTCB

Individuals must have applicable education or experience applying a body of standardized rules, procedures, or operations to perform the full range of standard clerical assignments and resolve recurring problems or to operate and adjust varied equipment for purposes such as performing numerous standardized tests or operations. "

The GPTLHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks and pre-employment drug screen.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.