Pharmacy Billing Coordinator

Position Summary

Responsible for review, interpreting and posting of Pharmacy Benefit Manager payments. Payment posting is a data entry position in a high production-based environment with time sensitive deadlines. Accurate application of payments is needed and attention to detail.

Essential Functions of the Job:

Reviews patient and prescription data in the pharmacy system.

Reviews claim submission for accuracy.

Review and Post payments in Pharmacy Benefit Manager portal.

Verify Deposits in Pharmacy Benefit Manager portal.

Download 835 files from Pharmacy Benefit Manager portal.

Organize and upload 835s to Epic FTP folder.

Load and post bank cash files.

Performs accurate posting of payments and denials.

Applies adjustments according to carrier’s adjudication and/or SYH posting procedures and contracts.

Reviews and clears errors on payments.

Coordinates the preparation of reports and written documentation, as required by the department.

Additional Duties and Responsibilities

Follows established departmental policies and procedures, quality assurance program, safety, environmental and infection control standards.

Enhance professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.

Review and submit prior authorizations as needed.

Performs other related duties as assigned by the Director of Pharmacy or Pharmacy Business Supervisor.

Job Requirements

Education Required:

High School Diploma or GED equivalent.

Certifications/Licenses Preferred:

Current Pharmacy Technician license from CA Board of Pharmacy preferred.

Experience Required (Minimum level of experience):

Minimum 2 years with claim adjudication/billing experience.

Preferred:

2 years of relevant medication prior authorization experience preferred.

At least some familiarity with EPIC.

Verbal and Written Skills Required to Perform the Job:

Bilingual (English/Spanish preferred. Good oral and written communication.

Technical Knowledge and Skills Required to Perform the Job:

Ability to organize and prioritize work to meet deadlines. Good oral and written communication skills. Knowledge of MediCal, Medicare and commercial insurance regulations preferred. Knowledge of medical terminology and familiarity with Epic systems preferred.

Equipment Used:

Computer and pharmacy software system (Epic).

Working Conditions and Physical Requirements:

Prolonged periods of sitting using a PC and constant walking and standing. Lifting no more than 15 lbs. Driving and occasional travel to other sites may be required. The ability to follow directions correctly and accurately is a must.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.