Pharmacy Billing Specialist

1 week ago


Cabin Creek, United States Pharmacy Solutions Group Full time
Job Summary

The Pharmacy Solutions Group is seeking a skilled Pharmacy Billing Specialist to join our team. As a key member of our operations team, you will be responsible for ensuring accurate and timely billing for our pharmacy services.

Responsibilities
  • Claims Processing: Verify and process medical claims for pharmacy services, ensuring accuracy and compliance with regulatory requirements.
  • Census Reconciliation: Conduct weekly census reconciliation, including Medicare, to ensure correct patient setup and billing.
  • Room Moves and Updates: Monitor and manage room moves, updating Framework accordingly.
  • Rebilling: Initiate rebilling process for payer changes and ensure timely completion of primary and secondary rebilling.
  • Batch Processing: Work primary billing batches in a timely manner and ensure accurate billing for assigned homes.
  • Customer Support: Provide timely responses to family billing questions and assist Accounts Receivable Analyst with customer notes and Medicaid pending group monitoring.
  • Third-Party Audits: Participate in third-party audits as requested by supervisor.
  • Training and QA: Assist with training and quality assurance initiatives.
  • Reporting: Run daily MOP verification reports and monthly composite batches.
Requirements
  • Education: High School Diploma or GED required.
  • Experience: Previous medical billing experience required.
  • Skills: Framework knowledge and pharmacy experience/background are a plus.


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