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About the Role
The Billing Specialist assists with pharmacy operations, focusing on billing pharmacy and medical claims and adjudicating rejections. This role is crucial for ensuring smooth operations and timely delivery of services.
Responsibilities
- Billing all claims (pharmacy and medical) and managing rejections to ensure appropriate follow-up and delivery promise times are met.
- Acting as a liaison between patients and insurance companies, and facilitating communication between patients and doctors, medical staff, and administrative staff.
- Resolving billing issues with payors.
- Ensuring adherence to CMS guidelines per Medicare and Medicaid guidance.
- Confirming billing accuracy and payor billing/shipping requirements.
- Processing and setting up deliveries to medical offices.
- Performing medical claims billing for both supplies and medications.
- Confirming financial aspects of claims prior to facility release.
- Managing portals, including refill reminders, processing orders, and completing patient registrations.
- Coordinating financial assistance with patients for foundation care, copay assistance, or free medication programs.
- Assisting Patient Care Specialists with workflow and calls, including maintaining patient records, filing, documentation, set up, data entry, financial arrangements, collecting co-payments, prior authorization assistance, and coordination of benefits.
- Promoting information sharing and continuous process improvement.
- Functioning in strict accordance with standard, written procedures and guidelines with deviation approved by the supervising pharmacist.
Requirements
- High school diploma or GED required.
- One (1) year of experience working in a high-volume pharmacy, or equivalent setting, required, or six (6) months as a temporary associate in the Reliance Rx Operations & Compliance department.
- Effective oral and written communication skills.
- Aptitude for working with other health care professionals.
- Ability to lift a minimum of 5 lbs.
- Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.
Skills
- Online claims processing system experience preferred.
- Communication skills
- Working with health care professionals
Location
- Williamsville
Work Type
- Hybrid
- Onsite training
- Full-time
Experience Level
- 1 year experience in high-volume pharmacy or equivalent
- 6 months experience as a temporary associate in Reliance Rx Operations & Compliance department
Education Level
- High school diploma or GED
- National Pharmacy Technician Certification (CPhT) preferred
Salary/Compensations
- $22.50 - $23.50 hourly
Benefits
- Scorecard incentive
- Full range of benefits
- Generous paid time off
About the Company
- We're excited about the potential people bring to our organization.
- You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Equal Opportunity
- As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
- Click here for additional EEO/AAP or Reasonable Accommodation information.