This position primarily involves ensuring the timely and accurate billing of medications and other supplies as ordered by facilities consistent with medical, administrative, ethical and legal requirements of federal and state regulations. This position is part of a team that is responsible for daily processing of claims involving medications for on-demand and cycle fill dispensing.
location: Palmetto, Florida
job type: Permanent
salary: $45,000 - 48,000 per year
work hours: 8 to 5
education: Associate's degree
experience: 2 Years
- Multiple payer claims adjudication and billing for pharmacy products and services provided to facilities, patients and employees. Payers include private insurances, private individuals, facilities, Medicare and Medicaid plans.
- Initiate, research and process required prior authorizations by insurance plan in a timely manner.
- Process patient information and/or paperwork accurately for billing purposes.
- Work with payers, patients and other appropriate parties on open items related to claims adjudication including clarification, research, problem identification and problem resolution
- Work with daily claim exceptions to ensure data integrity of claims.
- Respond to customer phone calls related to billing and patient records.
- Develop and maintain working knowledge of products and services and all applicable insurance guidelines respecting eligibility for coverage and reimbursement.
- Identify and report to management payer issues with regards to billing and collections.
- Process accounts and maintains appropriate records in a timely manner.
- Assist with end of month reconciling, billing and reporting.
- Work with management and other departments during audit.
- Assist with implementation of quality improvement program to meet company and accreditation standards.
- Comply with all applicable company policies and procedures.
- Comply with rules and regulations governing Medicare and Medicaid programs
- Other duties or special projects as assigned.
- Two years billing experience in pharmacy, hospital setting, LTC, insurance office or doctors office.
- Two years+ experience in general accounting preferred
- High school education required with college degree or college level business courses preferred.
- Knowledgeable in all major insurance reimbursement rules and regulations including eligibility for coverage by third party payers.
- Self-motivated and able to perform job responsibilities with a minimum of supervision.
- Knowledge of Microsoft Office applications such as Outlook, Word, Excel required.
- Excellent written and verbal communication and customer service skills required.
- Must be able to interact, cooperate, and communicate effectively with pharmacy customers, staff and management.
- Ability to work within strict deadlines. Must be highly organized and detail oriented and able to function effectively in a multi-task environment
skills: $100-250 million
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.