Pharmacy Billing Analyst - Fulltime - Bingham Farms
GENERAL SUMMARY:
Under minimal supervision, is responsible for resolving pharmacy adjudication rejections, as well as explaining COB related questions. Responsible for identifying and determining the accuracy and completeness of patient financial, insurance and demographic information, ensuring compliant claims to Third party payers, in accordance with established policies and procedures, as well as providing pharmacy support.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Accepts customer calls and provide accurate, satisfactory answers to their queries and concerns
- De-escalates situations involving dissatisfied customers offering assistance and support
- Accepts and processes all patient account payments.
- Provides support to internal and external customers regarding pharmacy copays, claim rejections, rebills, etc.
- Verifies patient insurance coverage and makes necessary changes in pharmacy system.
- Troubleshoots and resolves claim adjudication rejections for patients, physicians, pharmacies, and internal staff.
- Responds to insurance audits and claim reversals on behalf of all pharmacy sites, taking the proper steps to resolve receivables as a result of audit outcome.
- Identifies and resolves credit balances and understand the impact on patient responsibility and third party refunding.
- Monitors and manages various queues within pharmacy system.
- Evaluates and investigates claims on various reports to ensure proper billing and COB at pharmacy level.
- Submits third party medical and/or CMS1500 claim forms through the claims editing software. Understands the claim editing process and resolving the edits based on department procedures regarding claims submission.
- Converts pharmacy drug quantities into Medicare billing units according to Medicare Guidelines prior to submitting medical CMS1500 claim forms.
- Evaluates and investigates appropriation to be taken to submit automotive and worker’s compensation claims, which includes verifying COB and billing demographics.
- Manually generates invoices and submit to each participating nursing home of the First Fill Program, following the evaluation of the proper billing and appropriation to bill all claims correctly.
- Meets established quality and productivity expectations.
- Identifies, resolves, and reports potential issues to leadership.
- Supports the standards set forth in the HFHS Code of Conducts by adhering to legal and ethical standards.
- Performs other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- High school diploma or G.E.D. equivalent. Associates degree preferred.
- Minimum two (2) years of pharmacy technician experience required.
- Medical billing experience preferred.
- Knowledge of Medicare Part-B Billing Guidelines.
- Ability to analyze and improve billing procedures required.
- Strong understanding and knowledge of medical/clinical and pharmacy terminology.
- Working knowledge of personal computers, and business software such as Microsoft Office.
- Organizational and time management skills, as evidenced by the capacity to prioritize multiple tasks and job duties/responsibilities.
- Strong interpersonal communication skills and experience with interacting with customers.
CERTIFICATIONS/LICENSURES REQUIRED:
- Licensed/Certified Pharmacy Technician preferred.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.