Pharmacy Billing Clerk

Process Claims and Pharmacy Services

Process claims and works with health insurance carriers to receive compensation for pharmacy services, medications, and pharmaceutical supplies. Perform duties under the supervision of a registered pharmacist and/or licensed/registered pharmacy technician. They are not permitted to compound, fill prescriptions, handle control substances, or counsel patients.

ESSENTIAL FUNCTIONS

• Stock non-control medications under the direct supervision of a technician. • Stock supplies. • Obtain, organize, and assess data to track claims. • Prepare and submit claims to insurance companies. • Obtain necessary information to successfully process claims. • Answer questions from patients, staff, and insurance companies in a polite and friendly manner. • Register patients. • Coordinate with patients, healthcare practitioners, insurance companies, and others to obtain necessary information to bill and receive payment such as Prior Authorizations, Customer Agreements, Insurance, patient information. • Identify, modify, and/or enter incorrect or missing information required to submit insurance claims. • Create, prepare, and analyze reports to identify and investigate billing issues, reconcile claims, and maximize revenue. • Research and follow-up on rejected claims to receive maximum allowable payment. • Participate and perform audits to assess/maintain billing integrity. • Prepare status reports for items such as action taken, amount billed, pending, amount collected, not collected, and reason for denial of claims. • Coordinate with Finance and Accounting Office to reconcile accounts. • Verify proper reversal of insurance claims for return to stock or canceled prescriptions. • Identify, report, and help resolve system issues and/or other items in need of repair such as submitting a ticket or calling a vendor.

Responsibilities and Requirements

Adhere to policies and procedures to meet federal/state regulations and accreditation standards. Participate in departmental orientation, training, and quality assurance programs. Participate in department and hospital educational programs to maintain and advance current skill and competency levels; identifies and discusses performance or training needs with Supervisor. Perform other duties as assigned.

Requirements

• At least 18 years of age
• High School Diploma or the equivalent of a high school diploma
• BLS certification required within 90 days of hire
• One year of pharmacy or healthcare experience, preferred
• One year of pharmacy or medical billing experience, preferred
• Six months of customer service and/or clerical experience in a health care setting, preferred

Equal Employment Opportunity and Indian Preference

Indian Preference and Equal Employment Opportunity SCAHC gives preference in hiring to San Carlos Apache Tribal members and other Native Americans in accordance with the San Carlos Apache Tribe's Tribal Preference Policy, as set forth in Section 402 of the Tribe's Human Resources Department Policies and Procedures Manual. Otherwise SCAHC does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect him/her because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, citizenship, veteran status, military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, SCAHC complies with all applicable federal, and Tribal laws governing nondiscrimination in employment.