A LTC Billing Specialist will actively assist in the management and productivity of the pharmacy and billing department. Level 3 technicians will work with Rph and data entry tech to resolve billing claims and bill Long Term Care Facilities correctly.
Essential Functions of the Job:
Accurately, independently, and efficiently input and process insurance claims.
Submit prescriptions for third-party billing and trouble-shoot independently, using others as resources when necessary
Manage and maintain pharmacy workflow standards; look for improvements and efficiencies and communicate with others.
Work with other store staff and PLT/RLT to assist in training staff on correct insurance/medicare billing of prescriptions.
Proactively communicate and share information with patients, prescribers, and third parties to prevent and resolve issues; anticipate problems and resolve before patients arrive
Manage and submit Prior Authorizations
Accounts receivable, enter payments, send to collections when appropriate
Skilled nursing medicare A billing
Correct statements including rebilling, voiding, credits, and reprinting statements
Seek out feedback for continuous improvement and opportunities for growth
Assist other departments within LTC
Provide excellent customer service
Non-Essential Functions of the Job:
Other duties/responsibilities as may be assigned
Supervisory Responsibilities:
The billing specialist will not oversee any other employees, but rather work in conjunction with other billing personnel and data entry technicians to resolve billing issues
Supervisory Controls
Level of supervisory oversight and guidance is:
Position is self-directing in all essential functions.
Performance standards used to measure success in the employee’s performance of the functions of this job description will be determined by the supervisor.
All major issues, policy changes and recommendations are cleared first with the supervisor.
Qualifications & Skills:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Preferred Education/Experience:
High School Diploma or GED (required)
1 year of pharmacy experience or training as a technician
1 year of business and/or management or leadership experience
1 year insurance prescription billing
Skills:
Takes initiative
Leadership Skills - Coach others and use team-building skills within the pharmacy and with other departments
Lead a team by example; act as a servant to others
Assess workload and delegate as appropriate
Actively seeks out learning opportunities and applies new knowledge
Applies and teaches proactive problem-solving skills
Empathy and compassion
Attributes:
Motivated
Detail-Oriented
Excellent People Skills
Technical Skills
Work Environment:
The work environment characteristic described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions upon request. See all physical/environmental sheet attached.
Provided:
Computer
Software Program
Basic Office Supplies
Telephone
Friendly and knowledgeable work environment
Expected:
To maintain and actively practice proper business ethics and follow pharmacy laws
Abide by all Hometown Pharmacy Employee Standards of Conduct
During the course of business, an employee holding this position may have access to customer medical records, employment files and other information essential to our continued business success and must be maintained in a confidential manner.
Satisfactorily complete training and continuing education provided by Hometown Pharmacies
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request. See also the physical /environmental sheet attached.
Ability to lift and carry up to twenty pounds