Government Pharmacy Biller-Collector Per Diem Day Shift

Pharmacy Biller/Collector

Responsible for timely billing and follow up for all Part "D", Sub-Acute/SNF patients. Works all denials and or rejections in a timely manner. Works incoming correspondence. Works closely with the Pharmacy departments relating to the drugs and formulas. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.

Essential Functions:

• Knows how to download CMS/Epremise system daily or as needed.
• Monitors & processes credit balances for refunds and transfers in accordance with department procedures.
• Processes daily bills via CMS/Epremise system.
• Process claims and bills to payors through bill editor in accordance with department procedures.
• Knowledge in printing the Remittance Advices.
• Works on denial accounts daily or as needed.
• Works on daily rejection daily or as needed.
• Works on daily mail and correspondence.
• Responsible for working off the work ques and clearing ticklers efficiently.
• Maintains quality control on all accounts for correct plan ID's and financial class. Updates system with appropriate changes.
• Sends requests to ancillary departments for reports needed to bill claims in a timely manner.
• Responsible to keep current with updates and changes within the Medicare m via CMS website.
• Responsible to retrieve any patient information from the HBF system.
• Processes daily contractual adjustments. & calculates payment and contractual adjustment according to expected reimbursement.

• Works and resolves aged accounts.
• Identifies under and over payments.
• Ensures each account has detailed documentation as required by the department procedures.
• Meets productivity requirements daily.
• Provides Medicare RA's to cross over biller.
• Prepares credit balance reporting every quarter to Medicare.
• Demonstrates ability to reach decisions takes appropriate action and follow through within scope of responsibility, as defined by job description.
• Processes secondary billing and transfers in accordance with department procedures.
• Performs all other duties and special projects as assigned.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Completes and attends monthly training assigned.

Behavioral Standards:

• Exhibits customer and service-oriented behaviors in everyday work interactions.
• Demonstrates a courteous and respectful attitude to internal workforce and external customers.
• Communicates accurately and appropriately.
• Works well and efficiently under minimal supervision.
• Handles difficult situations in a discreet and professional manner.
• Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer's and co-worker's time; establishes and maintains effective relationships with customers and co-workers.
• Provides accurate and timely written and verbal communication of information in a manner that is understood by all.
• Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
• Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

• Contributes toward effective, positive working relationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Qualifications:

• At least two (2) to three (3) years of current experience in an acute care hospital setting, preferred.
• Computer skills preferred.

Preferred Licenses & Certifications:

WPV Tier I

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