PHARMACY BILLING SPECIALIST

4 weeks ago

Cabin Creek WV USA, United States CommuniCare Advantage Full time
The West Virginia Pharmacy Solutions Group is currently recruiting Pharmacy Billing Specialists to join our team.

Benefits

Our employees enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.

Qualifications/Experience Requirements

* High School Diploma or GED required.
* Previous Medical Billing experience required.
* Framework knowledge is a plus.
* Pharmacy Experience/Background is a plus.

Job Duties/Responsibilities

* Completing Action Summary for assigned homes on a daily basis
* Census reconciliation on a weekly basis including Medicare. This includes: 1. Verifying correct patient setup for monthly billing (i.e. validating Data set up correctly - MOP's, Medicare Days, invoice group, customer group, address, allergies, mrn) 2. Completing SQL Reports.
* Monitor and manage room moves and update in Framework.
* Begins rebill process based on payer changes.
* Primary Billing Batches worked in timely manner (2 to 3 days).
* Primary and Secondary Rebilling - Private Pay accounts, Medicaid approval, incorrect billing, etc. Communicate to management if Rebilling is not completed by the 9th of each month.
* Back up for daily deposit
* Back up for Hospice Med list and hospice rebilling
* Ensure assigned homes billed accurately and timely at month end. (LTC complete by 4th business day. Private pay residents billed by the 5th business day but no later than the 10th of each month.)
* Assist Accounts Receivable Analyst in the following: 1. Customer Notes- answer family billing questions for assigned homes in timely manner. 2. Monitor Medicaid Pending Group each month ensuring claims are rebilled once Medicaid approval is received. 3. Send BAE on Medicaid Approved Residents when needed.
* Third Party Audits as requested by supervisor
* Assist with Training and QA (Quality Assurance)
* Running Daily MOP Verification Reports (Outside MEDA, MCR Changed to GUAR, Outside MCR Days, Posted MOP Report)
* Monthly Composite Batches
* Assist with other projects as assigned

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