Point of Sale (POS) Pharmacy Billing Technician

Description

Under general supervision of the Pharmacy Director in coordination with the Revenue Cycle Department, the POS Pharmacy Billing Technician is responsible for non-formulary processing & review as well as accounts receivable support for the Pharmacy Department, which includes all three locations – Winslow, Leupp and Dilkon. The POS Pharmacy Billing Technician is responsible for pursing all avenues of payment, including patient assistance programs, non-formulary processes, etc that could result in reimbursement for Winslow Indian Health Care Center Inc. (WIHCC). Upholds the principles of WIHCC’s Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Maintains regular attendance and punctuality.
• Works with various (Pharmacy/Insurances/Pharmacy Benefit Managers (PBM), etc.) help desks to resolve problems with rejected claims or to obtain override code(s).
• Requests and obtains prior authorization (PA) for various pharmaceutical products from insurance companies.  Completes and obtains required documents, signatures, and keep an open line of communication with all those involved with the PA process (i.e. provider, insurer, patient, specialty pharmacy, etc.).  Follows up and updates the status of PAs as required or to condition.
• Works with Specialty Pharmacies including physicians and nursing to order new medications or request refills on behalf of patients for infusion clinic or dispensing.  In addition, receives and correctly places in the PickPoint system and notifies patients, nursing, or providers.
• Tracks and reports productivity on a monthly basis for reporting measures.
• Working with the Pharmacy Director, maintains and updates contracts between WIHCC and Pharmacy Insurers.  Maintains records and files in accordance with applicable regulations and guidelines.
• Maintains general files of directives, instructions, regulations, notices and correspondence related to Pharmacy Benefits.  Ensures there is documentation of all action(s) taken for adequate audit trails.  Provides documentation to the insurance companies when requested for an audit.
• Serves as a contact person for any questions or problems with pharmacy claims.
• Generates the Rejected Claims Report (RCR) and import into excel format using the RPMS Report and Information Processor (RRIP) on a monthly basis.  Also, generates other pharmacy related reports as requested.
• Uses the excel pivot tables to sort through the RRIP report to work on rejected claims in an orderly and efficient manner. Understands and interprets claim rejection codes to perform the research and gather the necessary data needed to correct and resubmit all rejected claims.  Utilizes Electronic Health Record (EHR) and RPMS as well as a variety of other source documents.
• Utilizes RPMS to perform the correct actions to fix rejected pharmacy claims. (i.e. Point of Sale and Patient Registration, etc).
• Prevents the occurrences of a rejected claim code from becoming “claim too old” status by fixing rejected claims in a timely manner.
• Responsible for self-education by reading all updated materials from various sources regarding pharmacy claims, pharmacy billing, point of sale and any other updates or newsletters, etc.
• Familiarity with pharmacy systems such as PickPoint and QFlow, and become familiar with new systems as they are introduced to the Pharmacy.
• Mentors and trains new and other employees.
• Attends meetings regarding revenue cycle and present updates when needed.
• Requires completion of tasks or duties assigned by a supervisor.
• Upholds all principles of confidentiality and patient care to the fullest extent.
• Adheres to all professional and ethical behavior standards of the healthcare industry.
• Adheres to WIHCCs Personnel Policies and Procedures, departmental policies, rules, and regulations.
• Interacts in an honest, trustworthy and dependable manner with patients, employees, visitors, and vendors.
• Possesses cultural awareness and sensitivity.
• Maintains compliance with all Human Resources requirements.
• Performs other duties as assigned.

Qualifications

Minimum Qualifications:

High School Diploma or GED required. Minimum of 3 years of experience in pharmacy or healthcare billing, experience with an IHS or Tribal/638 facility preferred. BLS certification required (may complete within 3 months of hire). Bilingual skills in English and Navajo language preferred. Must maintain a valid unrestricted and insurable driver’s license. Must successfully pass a background investigation and maintain suitable requirements for a Child Care position. This position is considered as a Child Care position, which requires a satisfactory background check investigation and is subject to the requirements of the Indian Child Protection and Family Violence Prevention Act, as amended (henceforth referred as the ICPFVP Act).

Knowledge, Skills, Ability

• Knowledge of RPMS/EHR systems.
• Knowledge and understanding of basic pharmacy/medical terminology.
• Knowledge of ICD-10 coding.
• Knowledge of accounts receivable and collections practices and policies.
• Knowledge of pharmaceutical nomenclature, including characteristics, strengths, and dosage forms of pharmaceuticals.
• Knowledge of pharmaceutical systems of weights and measures.
• Knowledge of strong work ethics in the workplace.
• Knowledge of basic application of confidentiality.
• Knowledge of duties and responsibilities of the position.
• Knowledge of basic computer skills, e.g. Outlook, Word, Excel, PowerPoint.
• Ability to work under the pressure of dealing with multiple tasks and constant deadlines, while maintaining an attention to detail and accuracy.
• Ability to maintain and adhere to strict confidentiality of medical information and guidelines in accordance with the Privacy Act, HIPAA, tJC, EMTALA, and OSHA rules and regulations.
• Ability to type proficiently
• Ability to be dependable in attendance and job performance.
• Ability to meet attendance, overtime (if necessary), and other reliability requirements of the job.
• Ability to accept and learn from feedback.
• Ability to effectively communicate both in written and verbal.
• Ability to provide exemplary customer service at all times.
• Ability to interact positively with others and possess great interpersonal skills.
• Ability to multitask and perform well under pressure.
• Ability to have self-confidence.
• Ability to be a great team player.
• Ability to accept and learn from supervisor/peer critique.
• Ability to be flexible and adaptable to the changing needs of the organization.

Physical Demands:

While performing the duties of this job, the employee regularly is required to walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.  The employee frequently is required to stand; climb or balance; and occasionally stoop, kneel, crouch, or crawl.  The employee must occasionally lift and/or move up to 25 pounds.   

Work Environment:

Work is performed in an office setting with a moderate noise level.  Work environment may involve exposure to physical risks, such as blood borne pathogens and/or working with hazardous drugs or chemicals.  Evening and/or weekend work may be required.  Extended hours and irregular shifts may be required.

As required by P.L. 93-638, absolute preference will be given to qualified Navajo applicants.  If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants.