Pharmacy Billing Specialist/PHAR TCH

Northern Light Health

Department: Pharmacy - Administration

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40

Work Schedule: No Hours Assigned

Summary :

Responsible for ensuring the integrity of pharmacy billing operations, and revenue for organizations across Northern Light Health. Position is focused on financial accuracy in billing and claims. Auditing and reconciling departmental charges, analyzing claim denials, and ensuring billing compliance to maximize revenue and prevent financial loss. Responsibilities include price updates, accurate NDC assignment to the bill, assist with third party audits, review pharmacy data and ensure appropriate charges and evaluating savings and pricing opportunities. This position is also responsible for creating and sharing reports with appropriate staff members. Other duties as assigned.

Responsibilities :

• Audits Outpatient Chemotherapy and Infusion centers for correct charges and reimbursement.
• Works across teams to resolve claim denials.
• Use Pharmacy Pricing Policy to determine patient charges.
• Assist with third party audits in relation to pharmacy transactions in a timely manner.
• Investigate, resolve, review charge errors to correct charge process issues.
• Use of the Daily Exceptions Report to flag high volume/high dollar transactions.
• Troubleshoot posting errors and resolve.
• Maintain supporting detail for audits or analysis.
• Involved with new processes and training for all other MOs.
• Other Duties.

Other Information :

• Pharmacy Technician License with Maine Board of Pharmacy.
• Certified Pharmacy Technician (CPhT) preferred.

Competencies and Skills

• Adobe Acrobat
• Electronic medical record software.
• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Human Capital, Supply Chain and Financial Software.
• Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
• Word processing, spreadsheets, data entry, database experience and other computer related skills.
• Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
• MS Teams
• Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
• Siemens Clinical software.
• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.
• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Credentials

• Required Pharmacy Technician

Education

• Required High School Diploma/General Educational Development (GED)Associate or bachelor’s degree in related fields preferred.

Required Experience

• 5 year/years of Relevant Work Experience

Working Conditions

• Potential exposure to hazardous materials.
• Work with computers, typing, reading or writing.
• Prolonged periods of sitting.
• Lifting, moving and loading less than 20 pounds.

Brewer, Maine, Corporate Office, Cianchette, Foundation, Finance, Human Resources, Legal Services