What are the responsibilities and job description for the Therapeutic Interchange Technician position at Polaris Pharmacy Services?
Therapeutic Interchange Technician
WHO WE ARE
Polaris Pharmacy Services is an industry leader in Long-Term and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies across the country. We are proud to offer competitive benefits, industry pay, and career advancement opportunities to all our team members.
OVERVIEW
The Therapeutic Interchange Pharmacy Technician manages rejected pharmacy claims to ensure maximum payer reimbursement and timely billing. This role involves accurate formulary application and billing for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements. Strong communication and responsiveness are essential to address customer needs professionally. Building trust and maintaining effective relationships with customers and co-workers is key to success.
RESPONSIBILITIES
- Communicates selected Therapeutic Interchange formularies and prior authorization criteria to external and internal staff.
- Communicates pharmacy benefit coverage and preferred product to facilities via phone, fax, email, or dashboard.
- Resolves pending therapeutic authorization changes promptly to make the next run or escalate to Therapeutic Interchange Pharmacist for an alternative intervention.
- Knowledge of Third Party Billing and claim resolution and adjudication
- Knowledge of FFS and PPS Billing
- Experience with census balancing and payor verification
- Verify Insurance/Medicaid coverage
- Knowledge of Dual Coverage, MCR D, and Commercial Plans of Long Term Care
- Assist with all customer billing inquiries in a courteous and professional manner
- Enter fees and charges in Framework LTC
- Follow all applicable government regulations including HIPAA
- Comply with departmental policies regarding safety, attendance, and dress code
- Overtime, holidays, and weekends may be required and/or expected
- Conduct job responsibilities by the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
- Other duties as deemed necessary by the Billing Manager
QUALIFICATIONS
- High School diploma or equivalent
- Registered Pharmacy Technician experience preferred.
- Expert knowledge of Sig codes and the ability to calculate accurate days supplies of billed medication.
- Two (1) year of pharmacy billing experience required (long-term care preferred)
- Framework LTC & General computer knowledge & 10-key Number Entry preferred
- Able to read, write, speak, and understand the English language
- Able to work in a fast-paced environment
- Basic computer knowledge skills required
- Basic math and analytical skills
- Proficient in Microsoft Word, Excel, and Outlook required
- Good organization/Attention to detail
- Reliable
- Able to work various shifts and days
- Adaptability to an ever-changing environment
PHYSICAL DEMANDS
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
- May sit or stand seven (7) to ten (10) hours per day
- The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
- May be necessary to work extended hours as needed
- May lift and/or move up to 50 pounds
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
HOLIDAY & PTO POLICY
- Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
- Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
- Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.
Please note, because we are a pharmacy most of our locations are open 24 hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.
BENEFITS for full-time employees
- Medical, Dental, and Vision insurance
- 401 (k) (available for Part Time & Full Time EEs)
- Company Paid Life insurance
- Short-term and Long-term disability insurance
- Tuition reimbursement
- Personal Time Off (PTO)
- Competitive pay with annual performance reviews and merit-based raises
- Career growth potential
- Annual on-site voluntary Flu Vaccines
- Employee referral bonus program
