Position Summary: Under the direction of the Director of Billing, the Mallatt’s Billing Specialist is responsible for billing pharmacy claims to insurance companies, supporting Mallatt’s Retail, Long Term Care, and Homecare pharmacies on all billing related processes and providing excellent customer service and care to patients, caregivers and medical providers.
Responsibilities and Duties:
- Provide pharmacy staff support for claims processing (electronically or with HCFA 1500 form), payer compliance requirements and related prescription documentation processes including prior authorizations.
- Verify patient eligibility and prescription benefits, preparation and submission of claims to insurance companies; commercial, Medicare, Medicaid, and other third party payers.
- Continually audit patient files and maintain corresponding documentation necessary to defend third party audits and maintain payer and company compliance.
- Review and prepare facility and patient statements monthly, pursue payment from delinquent accounts, arrange payment arrangements and collection accounts.
- Assist patients, caregivers and related providers with questions regarding insurance eligibility, coverage, related benefits and payments.
- Process and reconcile third party reimbursements, EOBs, patient payments, returns, and credits.
- Working knowledge or Microsoft Office and email systems.
- Strong oral, written and interpersonal skills- Must be able to clearly, concisely and effectively communicate with customers, facilities, other health care providers, suppliers and various layers of management.
- Ability to write routine reports and correspondence, effectively present information and respond to questions one-on-one and to small groups within the organization.
- Demonstrated ability to work in a fast-paced, changing environment and meet complex demands and tight deadlines.
- Strong organizational skills, including attention to detail and follow through.
- Demonstrated problem solving and decision making skills- Ability to proactively prevent, mitigate and defuse potential adverse events.
- HIPAA trained and/or the ability to work with and protect extremely confidential patient information.
- One to two years of experience in a related field; or one or two years related experience and/or training; or equivalent combination of education and experience.
- Long Term Care or Retail Pharmacy technician or billing experience preferred, but not required.
- Minimum of one year of customer service experience required.
- High School Diploma/GED Equivalent
Physical Job Requirements:
- Sitting or standing up to 10 hours per day
- Having a range of motion from kneeling to bending over to raising arms above head to retrieve stock
- Lifting and/or carrying up to 40 pounds
- Reading fine and/or small print
- Working off a computer screen for up to 10 hours a day
- Full Time
- 8 or 10 hours shifts, Monday through Friday, between 8:00AM and 7:00PM
- Saturday/Sunday rotation
- Insurance-Health, Dental, Vision
- Flexible Spending Accounts (FSAs)- Medical and Dependent Care
- Paid Holidays
- Earned Time Off
- Retirement Plan- 401(k) Plan, Employee Stock Ownership Plan (ESOP)
- Background check and pre-employment drug screen required.
- Mallatt’s Pharmacy will develop long term, trusting relationships with our community by providing unique services, fun products and valuable information to improve the quality of life for each individual.
Mallatt’s Pharmacy is an EEO/AA employer.