What are the responsibilities and job description for the Medical Billing Specialist position at KPH Healthcare Services?
Overview
Job Summary: Responsible for developing, improving and continuing the process billing of medical claims for specialty pharmacy facilities. Needs to communicate financial and clinical information to appropriate stakeholders (internal and external) to ensure payment for services.
Travel: Limited travel may be required. Travel to healthcare providers and to various business and management conferences required. Travel to Facilities for periodic training and review.
Scope of Responsibilities: Works under minimal supervision. Follows standard procedures to accomplish assigned tasks. Establish, manage, and communicate the process of billing medical claims for specialty facilities.
Responsibilities
Job Duties:
- Manages the existing process of medical billing in the specialty pharmacy space to ensure prompt submission and reconciliation of claims from specialty facilities.
- Collaborate with leadership to enhance and grow the medical billing process for all facilities.
- Provide timely reporting, feedback, and information to support the business operation and medical billing functions as necessary
- Provide insights regarding trends in medical billing to operations team
- Follow, create and improve the Policies and Procedures necessary to improve the functionality of the medical billing process.
- Knowledge of Excel spreadsheets is also essential.
- Possess strong accounting and organizational skills to effectively manage and maintain systems and processes associated with the position.
- Coordination with other pharmacy and finance staff for proper financial reporting of billing and receipts and clerical responsibilities as needed to include copying and filing
- Responsible for completing all mandatory and regulatory training programs
- Perform other duties as assigned
Qualifications
Educational Requirements:
- Minimum: High School Diploma or GED
- Preferred: Medical Billing/Coding certification, Pharmacy technician or related certification
Experience:
- Past experience in a customer service-related field
- Past experience in medical billing environment
- 12-24 months experience as a pharmacy technician
Special Conditions of Employment:
- Drug test
- Initial and continuous exclusion and sanction/disciplinary monitoring
- Any and all additional eligibility requirements based on the specific position
Attendance Requirements:
- Must be available, and on-time for scheduled work shifts.
- Must be able to work nights and weekends as required.
Job Skill Requirements:
- Broad knowledge of medications, physician orders, and pharmacy systems
- Strong communication skills
- Outstanding customer service skills
- Excellent organization skills
- Ability to multitask and prioritize
- Excellent computer and keyboarding skills
- Excellent Excel skills
- Successful completion of a pre-employment and/or random drug screening test
Required Training:
- HIPAA Privacy Course
- HIPAA Security Course
- Fraud, Waste, and Abuse Course
- MethGuard Course
- HIPAA Privacy CE Mastery Exam
- HIPAA Security CE Mastery Exam
- Fraud, Waste, and Abuse CE Mastery Exam
- MethGuard CE Mastery Exam
Behavioral Traits Required:
- Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and others you are in contact with
- Initiative: Must work within supervision guidelines and assume additional responsibilities
- Flexibility: Must be willing to work variable work schedules, nights and weekends, assist others as requested and available, and be willing to perform all assigned work
- Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences
- Involvement: Must enjoy the demands of the job and work with interest and enthusiasm
- Customer Service: Must provide superior customer service (for Noble customers, fellow employees and business partners), listen attentively to their needs and respond appropriately
- Safety: Must take care of equipment and employ good safety habits
- Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams
