HDM-OP Pharmacy FS Specialist

Location: Chicago, Illinois

Business Unit: Rush Medical Center

Hospital: Rush University Medical Center

Department: Home Infusion Solutions

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)

Rush offers exceptional rewards and benefits learn more at our Rush benefits page (

Pay Range: $20.19 - $31.80 per hour
Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.

Summary

This Specialty Billing Representative is responsible for managing billing and accounts receivable for the specialty pharmacy service line, including transplant, oncology, cystic fibrosis, infertility, and pulmonary therapies. This role ensures accurate and timely billing across medical and pharmacy benefit plans while maintaining compliance with payer and regulatory requirements. The position verifies insurance eligibility, reviews benefits, prepares routine billing reports, and prepares and manages monthly patient and payer statements. The Specialty Billing Representative processes and follows up on claim denials, underpayments, and overpayments to ensure appropriate resolution and reimbursement, and assists the pharmacy with Medicare audit-related billing information and patient balance collections.

Responsibilities

• Prepares and submits medical claims weekly for Oncology, Infertility, Cystic Fibrosis, Transplant, and Pulmonary therapies.
• Analyzes, resolves, and resubmits rejected or underpaid claims for payment.
• Identifies trends and recommends process improvement opportunities that will result in DSO reduction, superior collection rate and intervals, and reduced bad debt.
• Assists management with the training of new employees on all the outpatient pharmacy billing systems.
• Assists management and new employees on coding issues, payor contracts, and collection policies.
• Participates in special payer projects with management staff to ensure proper reimbursement per our contracts or patients' benefit levels.
• Interacts with patients and insurance carriers to resolve outstanding claims issues.
• Maintain a specified level of knowledge pertaining to new developments, requirements, and policies.
• Provides guidance to the pharmacy manager to ensure financial targets are met.

Other Information

Required Job Qualifications :

• Associate's degree from an accredited college or university.
• Minimum 3 years' experience with specialty or home infusion pharmacy billing.
• Minimum 1 year of Medicare (Part B) and Medicaid billing.
• Knowledge of billing procedures for all commercial and governmental payors.
• Knowledge of HCPC and ICD codes and maintains up-to-date professional knowledge of Medicare, Medicaid and insurance industry requirements for qualifying services.
• Excellent verbal and written communication skills with the ability to effectively communicate with others in a professional and helpful manner. Demonstrates ability to adapt to a changing environment.
• Possess the ability to work effectively with others as part of a team.
• Good organizational and time management skills.

Preferred Job Qualifications:

• BA or BS degree from an accredited university
• Minimum 2 years of experience as a pharmacy technician.
• In lieu of minimum education requirements, a high school diploma (or equivalent) and at least 6 years of relevant job experience may be considered. With additional consideration given if the candidate has at least 2 years of Medicare (Part B) and Medicaid billing.

Physical Demands:

• Maintains a neat, professional appearance while in the work environment.

Competencies:

• Computer skills (e.g., Microsoft Office, Windows)
• Copier and Fax machine efficiency
• Other office equipment as necessary

Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.