What are the responsibilities and job description for the Billing Specialist position at ProAct - PBM?
Scope of Responsibilities: The Billing Specialist operates under limited supervision and is responsible for ensuring accurate, timely, and compliant adjudication of mail order pharmacy prescriptions. This role requires strong judgment, the ability to follow established procedures, and the flexibility to respond to varying workload demands. The specialist supports both internal teams and external stakeholders by resolving billing issues, providing professional communication, and providing a high level of customer service.
Job Summary: The Billing Specialist ensures that claims are processed accurately and efficiently while providing professional communication and support to members, contracted clients, and internal teams. Primary duties include monitoring adjudication queues, addressing claim rejections, facilitating prior authorization requests, and responding promptly to inquiries related to rejections, overrides, or coverage determinations. Through consistent professionalism and attention to detail, the Billing Specialist contributes to the overall operational success and service quality of the ProAct Mail Order Pharmacy.
$17.50-18.00 per hour.
The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.
KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
Job Summary: The Billing Specialist ensures that claims are processed accurately and efficiently while providing professional communication and support to members, contracted clients, and internal teams. Primary duties include monitoring adjudication queues, addressing claim rejections, facilitating prior authorization requests, and responding promptly to inquiries related to rejections, overrides, or coverage determinations. Through consistent professionalism and attention to detail, the Billing Specialist contributes to the overall operational success and service quality of the ProAct Mail Order Pharmacy.
- Responsible for monitoring adjudication queue(s)
- Responsible for contacting members on non-covered items
- Facilitate prior authorization process for customers through designated PA portals.
- Provide professional communication to contracted clients and members.
- Provide timely resolution to all internal communication inquiries relating to rejections or overrides.
- Provides resolution to customer service issues to ensure member satisfaction.
- Maintain and keep reasonable production as determined by Mail Order Leadership
- May assist in orienting and training new employees.
- Responsible for completing all mandatory and regulatory training programs.
- Perform other duties as assigned.
- Minimum: High School Diploma or GED
- Preferred: Pharmacy technician or related certification
- Experience in a customer service-related field
- 6-12 months experience as a pharmacy technician preferred.
- Broad knowledge of medications, physician orders, and pharmacy systems
- Familiar with Enterprise billing options and practices surrounding claim submission through the insurance platform.
- Strong communication skills
- Outstanding customer service skills
- Excellent organizational skills
- Ability to multitask and prioritize.
- Excellent computer and keyboarding skills
- Successful completion of a pre-employment and/or random drug screening test
$17.50-18.00 per hour.
The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.
KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
Salary : $18 - $18