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  

CLASSIFICATION:  Non-exempt    

SUPERVISION EXERCISED:  None 

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  

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