Billing Operations Specialist

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. 

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.   

We are seeking team members who:

Are inspired and compassionate problem solvers;

Produce high quality work; 

Thrive in the excitement of the ever-challenging environment of modern medicine; and 

Are committed to achieving superior health outcomes for people living with rare and devastating diseases. 

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.  

Join the PANTHERx team, and define your own RxARE future in healthcare!

Work Location: Pittsburgh, PA

Job Classification: Exempt

Status: Full-Time

Reports To: Supervisor, Billing Operations 

Purpose:

The Billing Operations Specialist bills and collects assigned payer accounts.  The Billing Operations Specialist works closely with payers to determine billing guidelines for PANTHERx Rare Pharmacy as well as make collection calls daily on assigned accounts that are past due.  

Responsibilities:

• Bills specialty pharmacy claims, both NCPDP format and CMS 1500 format.
• Researches Electronic 837 capabilities.
• Collections on past due assigned accounts.
• Researches and processes refunds as required.
• Denials trending.
• Prepares Bad Debt Write-Offs as required.
• Reconciles member accounts as needed.

• Handles multiple tasks and meet deadlines.

• Other duties as assigned within scope of practice.

Required Qualification:

• Bachelor’s degree in business or related field required. Equivalent work experience may substitute education requirements.
• Detailed understanding of both Medical and Pharmacy billing/collections practices with all payer types 
• Excellent oral and written communication skills and able to communicate effectively with all levels of management.
• Strong problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make appropriate and timely decisions.
• Uses tact, sensitivity, sound judgement, and a professional attitude constantly. 
• Knowledge of Microsoft Office Suite, especially Excel, Outlook, and PowerPoint

Preferred Qualifications:

• 2 years of medical billing/collections knowledge in a specialty pharmacy setting
• 837 (EDI) medical billing knowledge

Work Environment:

 This job operates in a professional office environment.   This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax/copy machines.

Physical Demands:

 While performing the duties of this job, the employee is regularly required to talk or hear.  The employee frequently is required to stand; walk; use hands and fingers; handle or feel; and reach with hands and arms.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job. 

Benefits:

Hybrid, remote and flexible on-site work schedules are available, based on the position.  PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!   Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.  Of course we offer paid holidays too!

Equal Opportunity: 

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.