Submit timely, accurate invoices to payer for products and services provided.
Correctly determine quantities and prices for products and services billed.
Verify services and products are correctly authorized and required documentation is on file.
Review reports to maximize generic substitution opportunities.
Manage and collect patient balances prior to prescription dispensing, or in accordance with company policy.
Ensure all required documentation for billing is completed and accurate prior to claim submission (i.e., medical claims billing).
Process reimbursement checks/payment in accordance with policy.
Review price modify logs and ensure there are corresponding claims.
Review, research and resolve all third party chargebacks in a timely manner.
Assist with any third party audits, in accordance with company policy.
Process and file all claims in accordance with company policy.
Processing of prescription exceptions including prior authorizations, triaging of referrals to other locations, and proactively identifying copay assistance opportunities.
Responsible for proactive communication to patients and providers regarding referral/prescription status.
Responsible for maintaining a deep understanding of and assisting patients with assistance programs enrollment, such as Chronic Disease Fund, confirming patient eligibility and all required reporting and documentation.
Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians and third party payers.
Maintains subject matter expertise pertaining to all external billing practices including but not limited to third party adjudications, prior authorization, and patient financial assistance programs in order to coach pharmacy technicians and other support staff.
Basic Qualifications
High School Diploma or equivalent.
Pharmacy Technician license, preferred.
Experience communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients).
Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
Preferred Qualifications
Prefer six months of experience in a retail environment.
Experience in processes related to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance advice and adherence to timely filing limits.
Experience entering data into databases (e.g., MS Excel).
Job Type: Full-time
Pay: $15.00 – $25.97 per hour
Benefits:
- Employee assistance program
- Employee discount
- Health insurance
- Paid time off
Schedule:
- Monday to Friday
Ability to commute/relocate:
- Simi Valley, CA 93065: Reliably commute or planning to relocate before starting work (Required)
Experience:
- ICD-10: 1 year (Preferred)
Work Location: One location
Source: Indeed.com
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