Billing Coordinator - Specialty Pharmacy

Essential Duties & Responsibilities

• Manages the adjudication inboxes
• Assists with medical claims billing
• Responsible for troubleshooting orders with a rejected status; refill too soon, increase/decrease of dose, duplicate claim, and eligibility issues.
• Responsible for the reconciliation of the master claims queue
• Assist with billing projects, ie. Member AR report, COGS, etc.
• Ensures insurance information is accurate for correct adjudication.
• Assists patients in the re-enrollment of copay cards and patient assistance plans
• Communicates with patient assistance plans when necessary to obtain payment
• Assists with the timely initiation and resolution of prior authorizations
• Works with appropriate staff members to resolve claims issues
• Follow and aid in enforcement of all company policies and procedures.
• Respect and maintain confidentiality guidelines of HIPAA.
• Responsible for other duties as assigned.

Education and Experience

• High School Diploma or equivalent
• Certified and Registered Pharmacy Technician, (Colorado) in good standing required
• Registered with the State of Florida (Florida techs only) in good standing required, certification preferred
• Previous Prior Authorization or Claims experience is preferred 

Knowledge, Skills, and Abilities

• Demonstrates a high degree of personal responsibility regarding accuracy and quality of work.
• Demonstrates ability to work effectively and maintain expected productivity.
• Ensures accuracy of information being provided to Management for review.
• Schedules own time based on priorities.
• Demonstrates Excellent customer service and Professionalism
• Ability to multi-task
• Ability to communicate effectively, patiently, and courteously.
• Ability to work in a high pace, stressful environment.
• Should be independent and self-motivated.
• Maintains a good attendance record.

Work Environment / Physical Demands