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Billing Specialist

2 months ago

Annapolis, United States Altruix Full time
Job DescriptionJob Description

Job Summary

The Pharmacy Billing Specialist will be responsible for processing and adjudication of prescription claims to third party payers in a high-volume setting. Resolution of denials through communication and coordination with PBMs, MHA, insurance providers, clients, and patients will be necessary to facilitate this process. The Pharmacy Billing Specialist will initiate prior authorizations and assist providers in submitting the necessary documentation for approval. They will also be responsible for periodic review and correction of claim submissions throughout the pharmacy. The Pharmacy Billing Specialist will play an integral role in the daily operations at Terrapin and will work with individuals in various departments within the pharmacy. The ideal candidate will be self-sufficient and able to work in a fast-paced and changing environment.

Main Responsibilities


ProcessingAdjudication (60%)

  1. Process prescription claims in a cycle fill paradigm
  1. Contact PBM's and insurance companies to resolve third party rejections, underpaid claims and pricing disputes
  1. Assist patients and care providers in resolving insurance issues
  1. Work with the Terrapin team to ensure timely processing and delivery of medications

Prior Authorizations (20%)


  1. Review PA denials and initiate the PA process through CoverMyMeds
  1. Communicate with patients and care providers regarding Prior Authorizations
  1. Monitor and track PA StatusApprovals
  1. Process approved claims for medications in daily pharmacy workflow

Claims Review (20%)


  1. Review processing reports to identify and resolve incorrectly billed/underpaid claims
  1. Identify and capture unbilled claims
  1. Query patient eligibility portals to identify missingincorrect patient insurance plans
  1. Add and manage 3rd party payers in the pharmacy system

Minimum Qualifications


  1. High School Diploma Required
  1. Required: Certified Pharmacy Technician
  1. Preferred 2 years' experience with LTC pharmacy software (SuiteRxIPC preferred)
  1. Experience in data entry and pharmacy claims submissions
  1. Knowledge of the prior authorization process
  1. Basic knowledge of Excel, Outlook, Teams, and One Drive
  1. Excellent communication skills
  1. Ability to work independently and meet deadlines
  1. Great attention to detain and accuracy
  1. Ability to solve problems with minimal direction

Physical Requirements


The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:


  1. The employee is regularly required to stand, walk, and sit, as well as talk and hear.

  1. The employee is required to use hands to operate vehicles and office equipment.
  1. The employee must occasionally lift and/or move up to 30 pounds.
  1. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus.

Altruix is a values driven organization striving to fulfill our mission - to improve the lives of people through exceptional, caring pharmacy services - with HEART.

Hopeful - We believe in the power of the human spirit, that every person matters, and we find a way to say yes.

Ethical - We do what is right with honesty, integrity, and transparency.

Accountable - We take ownership of problems, welcome feedback, and seek continuous improvement.

Respectful - We treat every person with kindness and listen with an open mind.

Team-oriented - We put clients and providers first, act with humility, and work together for the well-being of others.

Benefit summary/EEOC Statement/Drug-Free and testing - Altruix offers a competitive salary and a comprehensive benefit package which includes medical, dental and vision plans through CareFirst (a Blue Cross Blue Shield plan); employer paid long-term disability coverage and life insurance; an employer matched 401K plan; paid time off and paid holidays.


Altruix is an Equal Opportunity Employer and does not discriminate in recruiting, hiring, placement, training, promotion, termination, layoff, recall, transfers, leaves of absence, compensation, and other employment practices on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, genetic information, disability status, protected veteran status, or any other trait protected by federal, state, or local laws. Altruix is a drug-free work environment and requires pre-employment drug and alcohol testing as a condition of employment.