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Ardon Health · 4 weeks ago

Lead of Referral & Billing Services, Pharmacy Technician

Portland, OR

Full-time

Onsite

Mid, Senior Level

$29.53/hr - $36.92/hr

2+ years exp

Ardon Health is an award-winning specialty pharmacy dedicated to improving lives through high-quality healthcare services. They are seeking a Lead of Referral & Billing Services to provide leadership and support for billing, insurance, and referral management processes, ensuring timely completion of work and addressing escalated inquiries.

BiotechnologyHealth CarePharmaceutical

Comp. & Benefits

Responsibilities

Provides day-to-day leadership, guidance, and direct support to the Billing and Resource Teams to successfully achieve patient service goals and meet individual patient needs

Plans, prepares, and devises work schedules according to budget and workload

Trains, coaches, and motivates staff for the successful performance of the department and achievement of company objectives

Monitors staff members’ performance and schedules according to departmental standards. Provides effective two-way feedback to motivate high performance and a productive environment

Assists with development, monitoring, and response to department and employee reports for quality, service levels, productivity, and other markers. Monitors and measures against markers

When directed, communicates items of potential operational impact to leadership as appropriate. Coordinates responses to escalated payer inquiries and communicates escalated patient needs to payers, with guidance from operational leadership

Responsible for application tasks, including but not limited to:

Processing incoming documents

Maintaining patient records

Loading insurance information

Performing prescription data entry

Processing prior authorization notices

Performing and reviewing claim submission and reversal

Addressing billing exceptions

Support accounts receivable processing needs

Reports any identified obstacles or improvements to workflow to operational leadership

Troubleshoots adjudication issues and is well versed in the nuances of insurance billing and benefits investigation

Fields multi-department email requests and addresses issues or facilitates routing to alternate department

Supports creation and revision of team process documents

Supports call center when business needs arise

Interacts with all areas of Ardon Health to correct or enhance specific implementation activities as identified through customer service issues (billing, coordination of benefits, payment processing), observation, and communication with patients or group contacts

Assists manager with testing new processes, developing training and operational materials, and writing business requirement documents

Maintains active Oregon license. Informs supervisor within 1 business day (and Oregon Board of Pharmacy within 10 days) of any arrests, convictions, suspected or known violations of law, or any other conduct that might affect or has affected license status. Reports to Oregon Board of Pharmacy within 15 days any changes to name, residence address, or employment

Actively participates and provides support as needed to leadership and quality program staff to ensure activities related to the company’s quality management program and quality improvement activities maintain priority focus and are effectively executed. This may include but is not limited to activities that promote objective and systematic measurement, monitoring, and evaluation of services and defined Quality Improvement Projects (QIPs) that may result from such efforts

Complies with the company’s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities

Performs other duties and responsibilities as assigned

Qualification

Oregon Pharmacy Technician LicensePharmacy experienceCustomer service experienceInsurance billing knowledgePrescription intake knowledgeComputer proficiencyMulti-taskingCommunication skillsTeamworkProblem-solving

Required

High school diploma or GED

Active Oregon Pharmacy Technician License

A Certified Oregon Pharmacy Technician License will be required prior to expiration of existing Oregon license or as required by the Oregon Board of Pharmacy

Must be able to be innovative, solution-oriented and to strive for best practices

Must be able to shift direction based on business needs while successfully remaining focused

Must demonstrate excellent customer service skills and the ability to express compassion and empathy

Must be able to multi-task and work in a fast-paced environment

Must demonstrate teamwork and a positive outlook

Must have excellent verbal, written, and interpersonal communication skills

Must be able to express oneself, detect, perceive, observe, and assess information exchanged in a variety of communication methods

Must be able to demonstrate proficiency with computer applications

Must be able to work independently as well as part of a team

Must be able to provide timely, accurate, courteous, and concise responses to escalated inquiries in person, by telephone, or by correspondence

Must have strong knowledge of prescription intake requirements, insurance plans, and patient assistance programs with the ability to assist patients to coordinate insurance benefits and/or explore options for copay and other financial assistance

Must be able to manage and support special projects as assigned

Must be able to manage escalated issues that occur within pharmacy software system work queues

Must be able to understand and interpret claims adjudication issues with Pharmacy Benefit Management organizations, insurance plans, and Patient Assistance Programs

Must be able to accurately utilize applicable computer software and equipment for pharmacy claims processing

Preferred

Successfully meets all essential functions of Billing and Insurance level I and level II positions and/or Referral Resource Specialist level I and II positions and/or equivalent experience

Prior work experience in a customer service setting

Minimum 2 years' work experience in a pharmacy setting

Work experience in a specialty pharmacy setting