Pharmacy Benefits Specialist

    Highlights

    These responsibilities will include: Appointment scheduling; Obtaining prior authorizations; Ordering; Inventory tracking & reconciliation; Collecting patient-due amounts; and other needed tasks. At the end of each day run scheduling and charge reports to ensure that Buy & Bill and Specialty Pharmacy injections have been billed appropriately.

    Numbers & Facts

    LocationShelby, NC

    Description

    General Summary: A nonexempt position responsible to coordinate the activity of pharmaceuticals, such as Xolair, for the practice. These responsibilities will include: Appointment scheduling; Obtaining prior authorizations; Ordering; Inventory tracking & reconciliation; Collecting patient-due amounts; and other needed tasks

    Essential Job Responsibilities:

    • Determine if the pharmaceutical should be handled as Buy & Bill or Specialty Pharmacy
    • Obtain pre-authorization for drug purchase
    • Order pharmaceutical from the drug company
    • Assist patient with copay assistance
    • Provide estimates to patients on their financial responsibility
    • Checks and balances to verify that we are ordering and billing correctly
    • At the end of each day run scheduling and charge reports to ensure that Buy & Bill and Specialty Pharmacy injections have been billed appropriately
    • Collect patient-due amounts
    • Accounts Receivables - follow up, denials monitoring and appeals
    • Monitor and track drug inventory per location
    • Other tasks as requested by supervisor

    Education: High school diploma or equivalent.

    Experience: At least 1 year of insurance verification, and charge auditing

    Other Requirements: None

    Performance Requirements:

    Skills:

    • Ability to multi-task
    • Attention to detail
    • Ability to read accounts and understand medical terms
    • Excellent customer service and communication skills
    • Exhibit high level of professional behavior
    • Ability to learn quickly and work well under pressure
    • Ability to work independently and as a team

    Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

    Work Environment: Position is in a well-lighted office environment.

    Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.

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