Pharmacy Billing Clerk

Process claims and works with health insurance carriers to receive compensation for pharmacy services, medications and pharmaceutical supplies.  Perform duties under the supervision of a registered pharmacist and/or licensed/registered pharmacy technician.  They are not permitted to compound, fill prescriptions, handle control substances, or counsel patients.

ESSENTIAL FUNCTIONS

• Stock non-control medications under the direct supervision of a technician.  Stock supplies.
• Obtain, organize, and assess data to track claims.
• Prepare and submit claims to insurance companies.  Obtains necessary information to successfully process claims.
• Answers questions from patients, staff, and insurance companies in a polite and friendly manner.  Register patients.
• Coordinate with patients, healthcare practitioners, insurance companies, and others to obtain necessary information to bill and receive payment such as Prior Authorizations, Customer Agreements, Insurance, patient information.
• Identify, modify, and/ or enter incorrect or missing information required to submit insurance claims.
• Create, prepare and analyze reports to identify and investigate billing issues, reconcile claims, and maximize revenue.
• Research and follow-up on rejected claims to receive maximum allowable payment.
• Participate and perform audits to assess/ maintain billing integrity.
• Prepare status reports for items such as action taken, amount billed, pending, amount collected, not collected, and reason for denial of claims. 
• Coordinate with Finance and Accounting Office to reconcile accounts. 
• Verify proper reversal of insurance claims for return to stock or canceled prescriptions.
• Identify, report, and help resolve system issues and/ or other items in need of repair such as submitting a ticket or calling a vendor.
• Adhere to policies and procedures to meet federal/ state regulations and accreditation standards.
• Participate in departmental orientation, training, and quality assurance programs.
• Participate in department and hospital educational programs to maintain and advance current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
• Perform other duties as assigned.