PHARMACY BILLING SPECIALIST

Perform duties to process pharmacy billing with focus on accuracy, timeliness, and adherence to process, to reduce denial rate while working within the limits of standard or accepted practice.

POSITION RESPONSIBILITIES:

• Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit billing to payers for reimbursement, via paper bills and clearing house submittals.
• Review electronic error messages and identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
• Review claims with outstanding balances and identify actions to successfully collect revenues.
• Act as liaison between patients and insurance companies.
• Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding claims issues.
• Assist Pharmacists and Customer Service with the billing process, including taking payments over the phone.
• Answer patient questions regarding billing statements.
• Follow proper protocol to ensure full compliance with CMS billing guidelines.
• Perform other related duties as assigned.

COMPETENCIES:

• Effective communications skills; listening, speaking, understanding, and writing English while influencing patients, care givers, payer representatives and others, answering questions and advancing reimbursement and collection efforts.
• Understanding of processes, systems and techniques to ensure successful billing and collection working with all payer types.
• Proven ability to identify gaps and problems from review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
• Excellent computer skills with proficiencies with Microsoft Suite (Word, Excel and Outlook) and

billing systems.

EDUCATION/EXPERIENCE:

• High School Diploma or equivalent required.
• Minimum of one year’s experience working in pharmacy with background in pharmacy claims billing. Prefer working knowledge of long-term care pharmacy billing, commercial insurance, and Medicare and Medicaid reimbursement.
• Working knowledge of automated billing systems, experience with pharmacy processing systems.