What are the responsibilities and job description for the Pharmacy Billing Clerk position at San Carlos Healthcare Corporation?
Process claims and works with health insurance carriers to receive compensation for pharmacy services, medications and pharmaceutical supplies. Perform duties under the supervision of a registered pharmacist and/or licensed/registered pharmacy technician. They are not permitted to compound, fill prescriptions, handle control substances, or counsel patients.
ESSENTIAL FUNCTIONS
- Stock non-control medications under the direct supervision of a technician. Stock supplies.
- Obtain, organize, and assess data to track claims.
- Prepare and submit claims to insurance companies. Obtains necessary information to successfully process claims.
- Answers questions from patients, staff, and insurance companies in a polite and friendly manner. Register patients.
- Coordinate with patients, healthcare practitioners, insurance companies, and others to obtain necessary information to bill and receive payment such as Prior Authorizations, Customer Agreements, Insurance, patient information.
- Identify, modify, and/ or enter incorrect or missing information required to submit insurance claims.
- Create, prepare and analyze reports to identify and investigate billing issues, reconcile claims, and maximize revenue.
- Research and follow-up on rejected claims to receive maximum allowable payment.
- Participate and perform audits to assess/ maintain billing integrity.
- Prepare status reports for items such as action taken, amount billed, pending, amount collected, not collected, and reason for denial of claims.
- Coordinate with Finance and Accounting Office to reconcile accounts.
- Verify proper reversal of insurance claims for return to stock or canceled prescriptions.
- Identify, report, and help resolve system issues and/ or other items in need of repair such as submitting a ticket or calling a vendor.
- Adhere to policies and procedures to meet federal/ state regulations and accreditation standards.
- Participate in departmental orientation, training, and quality assurance programs.
- Participate in department and hospital educational programs to maintain and advance current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
- Perform other duties as assigned.