Pharmacy Medical Billing Specialist

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Position: Pharmacy Medical Billing Specialist

Location: Louisville, KY

Job Id: 5996

# of Openings: 1

Make a difference! A diagnosis unlike any other, deserves a pharmacy unlike any other. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

We are hiring a Pharmacy Medical Billing Specialist at our Onco360 location in Louisville, KY.

Starting salary at $23 an hour.

8:00-4:30 or 8:30-5 EST Monday through Friday.

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.

We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

We offer a variety of benefits including:

• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement; Quarterly Incentive Bonus; Referral Bonus
• Company paid benefits – life insurance; and short and long-term disability

The Pharmacy/Medical Billing Specialist, reporting to the Billing Manager, is responsible for end-to-end billing of company specific IV and oral therapies on pharmacy platform (currently CPR+). Daily functions require working knowledge of HCPC coding, ICD-10, Jcodes, CPT as well as NDC specific claim billing. Individual must be able to perform the essential functions of this position as listed below.

Pharmacy / Medical Billing Specialist Major Responsibilities:

• Research proper billing policies and procedures for all payer types, ensure claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
• Manage and process claims for all confirmed Ready to Bill tickets; perform Quality Assurance to ensure accurate and timely creation of electronic claims and paper invoicing. Review delivery tickets for accuracy and complete claims per payer specific guidelines. Identify patterns of non-compliance by branch staff in completing patient registration, supporting documentation and delivery tickets. Process confirmed tickets within 24 hours of confirmation. Notify benefit verification team of any demographic changes to reduce rejections of submitted electronic and paper claims.
• Manage all Funding related billing follow up and work as liaison to Onco360 Advocate team.
• Proficient at reading and interpreting EOB’s and all forms of payer/insurance correspondence.\
• Efficiently uses company billing software platform, including maintaining accurate and detailed patient and billing notes to assist in documentation and collection of claims.
• Must be able to communicate both verbal and through written correspondence with the insurance company, healthcare provider, and patient to get claims processed and paid appropriately, including creating Redeterminations and Appeals if necessary.
• Have a working knowledge of electronic claim adjudication, familiar with NCPDP 5.0 standards and rejections. Able to complete claim updates and corrections as needed.
• Serve as a resource for patients on billing and accounts receivable inquiries, including but not limited to understanding of copay structure, accepting patient payments and the like.
• Work within specified deadlines and open to overtime when necessary to meet department goals and objectives.
• Performs other tasks as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Pharmacy / Medical Billing Specialist Qualifications

• Education/Learning Experience
  • Required: High School Diploma or GED
  • Desired: Associate degree or higher in a related field
• Work Experience
  • Required: 1-3 years of Medical or Specialty Pharmacy Infusion Billing
  • Desired: 3+ years’ experience in Specialty Pharmacy and/or Infusion Billing
• Licenses/Certifications
  • Desired: PTCB/CPhT
• Skills/Knowledge
  • Required: Must have excellent interpersonal skills and be able to work with all levels of management and staff, both technical and non-technical. Strong, independent decision-making abilities are required. Must be able to conduct research, be resourceful, and self-reliant. Excellent communication skills including negotiation skills; must be persistent and persuasive.
• Required: Strong work ethic with excellent time management skills, excels at working independently but collaborative in a group setting as well. Detail oriented, proficient at prioritization of workload