Pharmacy Billing Specialist (Amber Specialty Pharmacy)

Additional Considerations (if any):

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At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions.

• Monday-Friday (no weekends)

• Hours: 7 am - 6 pm CST; varied shifts (to equal 40 hours per week)

• Six paid holidays

• Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.

Amber Specialty Pharmacy

Job Title: Pharmacy Billing Specialist

Department: Operations

FLSA: Non-Exempt

General Functions

The Pharmacy Billing Specialist ensures accurate insurance information is received and stored. They gather all necessary information to bill electronic NCPDP claims in the appropriate order in the event of multiple payers, review statements to determine accuracy, and navigate financial assistance programs to help patients gain financial support. Communicating with coordinators and co-workers regarding insurance verification and promoting exceptional customer service and professionalism with the community is vital in this position.

The Training Billing Specialist is responsible for boosting the competencies of our employees by developing and conducting effective training documents. Indirectly help enhance the employee’s workplace performance with the Company’s core values. Will be performing the training needs assessment and learning materials for the billing team.

Reporting Relations

Reports to: Lead Pharmacy Billing Specialist

Direct Reports: None

Primary Responsibilities:

• Consults with patients to resolve all types of payer and coverage issues.

• Contacts the patient, when necessary, to gather insurance and billing information or notify of a delay in processing.

• Conducts a benefits investigation, updates patient accounts, prescriptions, etc.

• Collects outstanding patient balances.

• Processes adjudication rejections, insurance terminations, and insurance changes.

• Handles patient benefit statement questions to a conclusion.

• Researches and reviews patient inquiries on account balances.

• Knows Amber HIPAA policies and maintains patient confidentiality at all times.

• Works as a team member with all other departments to verify benefits.

• Working knowledge of all necessary computer software to perform job duties.

• Bill claims via electronic NCPDP clearinghouse; cross-trains in Medical billing as time allows.

• Works claims in the clearinghouse to ensure our payers receive them.

• Responsible for aiding in accounts receivable by billing claims correctly and getting them to our payers on time.

• Works with team to achieve Company AR goals.

• Understanding of payer contracts and how claims should be submitted to each payer.

• Has mastered the requirements of a Pharmacy Billing Specialist so they can train new hires on company policies and procedures, including HIPPA policies.

• Gather and evaluate information from employees and management on previous training to identify strengths, weaknesses, and areas that need improvement.

• Inform employees on scheduled training and track their progress.

• Instruct employees to complete a benefits investigation and update patient accounts, prescriptions, etc.

• Trains new hires and teams on adjudicating rejections, insurance terminations, and insurance changes.

• Educates new hires and the team on how to review statements and patient balances.

• Trains new hires and teams on computer software and programs to perform job duties.

• Teaches new hires and team the difference between medical and NCPDP billing.

• Assists in developing SOP and training documents to perform job duties.

• Monitors new hires and teams on their progress and ensures how to perform job duties.

• Assist the Lead Pharmacy Billing Specialist in training needs; document the employee training.

Professional Competencies:

• Proficient with MS Excel, Word, and Outlook.

• Strong oral, written, organizational and interpersonal skills.

• Ability to work in a team and with all levels of internal management, staff, outside clients, and vendors.

• Demonstrated ability to meet tight deadlines.

Required Qualifications:

• Working knowledge of the healthcare industry, specifically the pharmacy industry.

• One (1) year of experience billing electronic insurance claims, including; Medicaid, Medicare, and Commercial insurance via NCPDP clearinghouse.

• Experience working with clearinghouses for claim adjudication.

Educational Requirements:

High school diploma or equivalent.

Physical Requirements:

• Must remain stationary up to 90% of the time

• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and traverse conferences, meetings, and remote events.

• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

• The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

• The ability to observe details at close range (within a few feet of the observer).

Working Conditions:

Normal Office Environment.

Equipment Used to Perform the Job:

Computers, keyboards, mouse, monitors, fax, and/or headsets for phone work. Software specific to the position, including but not limited to Microsoft Outlook and Skype. Must lift and traverse the area to move paper and supplies to use the equipment.

Contacts:

Frequently interact with co-workers, intradepartmental staff of the Company, payers, insurance, supplies, managers, leaders, vendors, and customers.

Confidentiality:

The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. The Company does not consider this an exhaustive list of examples and may add or modify as deemed appropriate to the execution of the role.

Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Apply now and join our mission to provide exceptional patient care!