Billing Specialist II

Essential Job Functions

• Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Reverify benefit coverage criteria as needed for claims follow up.
• Accurately enters and/or updates patient/insurance information into billing system.
• Maintain and continually audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance.
• Accurately enter patient information into the pharmacy system.
• Provide assistance and timely response to all billing customer inquiries via phone or electronic communications.
• Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Uses working knowledge to troubleshoot and resolve customer service issues.
• Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods.
• Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money.
• Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned.
• Process patient payments, returns, and credits.
• Transmit individual credit card payments as needed.
• May pursue payment from delinquent accounts and make payment arrangements.
• Research, identify and organize requested audit documentation in timely manner.
• Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed.
• Make corrections as needed and rebill claims as necessary.
• Demonstrate knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions.
• Exercise proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements.
• Consistently meet pharmacy's established accuracy and productivity levels.
• Follow all applicable government regulations including HIPAA.
• Work as a collaborative team member to meet the service goals of the pharmacy.

Education and/or Certifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).

Skills and Qualifications

• 2+ years related experience including a minimum of 6 months billing experience in long term care or retail setting.
• Advanced computer skills; pharmacy information system experience required.
• Ability to work independently and deliver to deadlines.
• Great attention to detail and accuracy.
• Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines.
• Quality minded; motivated to seek out errors and inquire about inaccuracies.