Billing Technician - VALUE DRUG COMPANY : Job Details

The purpose of this position is to support the Billing Department and Billing Manager and Reimbursements in a variety of tasks in compliance with state and federal laws and regulations as well as company policies.Essential Functions

Gather data from patients, pharmacies and insurance companies to complete claims processing

Verify payer sources and insurance eligibility

Prepare and submit clean claims to various commercial insurance companies, Medicare Part D, and Medicaid using both electronic and paper submission methods

Process and understand claims coordination of benefits (COB) for secondary billing

Contact insurance companies to make inquiries regarding claim denials or resubmissions

Identifies, researches, and resolves problems related to third party payers

Review clinical documentation to ensure compliance with Medicare guidelines

Identify and validate ICD-10 codes and HCPC Codes as appropriate for products dispensed through pharmacy claims and medical claims

Process daily and monthly invoices

Process and maintain manufacturer reports and submit in accordance with data agreement timeline

Process and maintain data on Maximum Allowable Cost appeals (MAC) to obtain the most accurate pricing through payers

Review and interpret EOBs for claim collection and follow up

Reconcile payments from payers, post adjustments and credits to patient accounts

Participate in third party and Medicare claim audits to minimize financial discrepancies

Assist with medical claims processing to ensure proper documentation and patient information to process clean claims

Process credit card transactions daily and apply payments

Assist with patient financial assistance through foundations

Assist pharmacy staff with all electronically adjudicated claims to ensure prescriptions are reconciled and paid for prior to delivery

Build and maintain relationships with payee representatives

Protect patient confidentiality, according to HIPAA guidelines

Attend at all meetings, conference calls, off site meetings etc. at the discretion of Billing Manager

Other duties as assigned

Work EnvironmentThis position operates as a hybrid position with 40% of shifts on site at pharmacy location. Position has a high call volume and receives periodic supervision.CompetenciesKnowledge of insurance procedures, billing requirements and bookkeeping required. Requires computer and calculator skills, expert customer service skills, ability to understand and follow policies and procedures, written and oral communication proficiency, accuracy, time management, teamwork, collaboration skills, organizational skills, expert telephone skills, ability to handle frequent interruptions, and email skill. Ability to meet tight deadlines and handle changing priorities and emergencies.Physical demands typical of this positionThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit or stand for long periods of time, walk, use hands and fingers to operate a computer keyboard, mouse, and other computer or office equipment. Visual acuity to read printed material and a computer screen and ability to concentrate. May require bending, climbing and occasional lifting of up to 30 lbs.Supervisory ResponsibilityN/ATravelN/ARequired Education and ExperiencePreferred Education and ExperienceRetail pharmacy experience and/or experience with medical and pharmacy billingSecurity Clearance/Background CheckPass a federal background check and drug screen.AA/EEO StatementIf required.Other DutiesThis job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee.Other duties, responsibilities and activities may change or be assigned at any time with or without notice.