Tuba City Regional Health Care Corporation ยท 14 hours ago
Pharmacy Billing Technician (DHPI10)
Tuba City, AZ
Part-time
Onsite
Entry Level
1+ years expTuba City Regional Health Care Corporation is committed to providing quality healthcare services and has implemented an Affirmative Action Plan under the Navajo Preference Employment Act. They are seeking a Pharmacy Billing Technician who will primarily process third party claims for pharmaceuticals, ensuring accurate billing and collection for patients covered by insurance policies.
Health CareHospitalMedicalWellness
Responsibilities
Attempt to collect any self-payment(s)/copayment(s) amount owed by non-beneficiary patient at point of sale or via reporting
Ensure open professional communication to Patient Registration, Pharmacies, Patient Benefit Coordinators, Prior Authorization Team, Patient Access Specialists, Accounting Technicians, TPMS and 3rd Party Help Desk
Receive the pharmacy prescription dispensing reports electronically via on-line billing system. Determine if the prescription written by the provider is billable as defined by insurance guidelines. Verify prescription amount dispensed for reimbursement by Pharmacy
Familiar with Prescription Insurances; Medicaid, Medicare, Part D and Commercial Plans
Request and obtain prior authorization for various pharmaceutical products from insurance companies. Receive and complete authorization forms providing all data required, obtains signatures, and returns as needed for processing of collection
Resolve problems associated with on-line billing. Research and follow-up on rejected claims on-line in order to ensure maximum reimbursement to the facility, including telephone contacts and any steps necessary for satisfactory resolution of the claim
Ensure pharmaceuticals are billed according to Dispense-As-Written (DAW), Drug Utilization Review, Dosaging, and Payer Format (BIN #) guidelines. Manage and reconcile rejects through interpreting clinical messages, DUR specification codes, and appending/amending claims for payment
Comprehend terminology for pharmaceutical products and correlate medical and clinical procedures and services provided by the facility against terms of the policies
Ability to use system applications to operate daily pharmacy production
Manage A/R Reports, In-House rejection, denial reports and audit reconciliation of all transactions/scripts
Prepare end of the month and quarterly status reports that list amounts billed, collected and not collected
Work rotational shift, Sunday through Saturday, as scheduled
Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield
Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction
Performs other duties as assigned
Qualification
Required
High School Diploma or GED
Minimum of one (1) year experience related to pharmaceutical terminology, billing, or general pharmacy operations
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers
Positive working relationships with others
Possession of high ethical standards and no history of complaints
Reliable and dependable; reports to work as scheduled without excessive absences
Working effectively in team relationships
Completion of and, above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC
Ability to lift up to 10 pounds
Ability to walk for short periods of time
Ability to sit for long periods of time
Ability to stoop and pick up objects from the floor without restrictions
Full use of hands and arms for simple/firm grasping, fine manipulation, and use of keyboards
Prolonged use of near vision, color vision, depth perception, seeing in fine details, hearing normal speech, hearing overhead pages over a loudspeaker, and utilize a telephone
Ability to cope with high level of stress
Ability to make decisions under high pressure
Ability to cope with anger/fear/hostility of others in a calm way
Ability to manage altercations
Ability to concentrate
Ability to handle high degree of flexibility
Ability to handle multiple priorities in stressful situation
Ability to demonstrate high degree of patience
Ability to adapt to shift work
Ability to work in areas that are close and crowded
Ability to work alone
Ability to ensure proper PPE is worn at all times while on duty
Ability to complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly
Ability to complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease
Company
Tuba City Regional Health Care Corporation
The Tuba City Regional Health Care Corporation (TCRHCC) is a 73-bed, acute and outpatient regional health system organized as a private nonprofit healthcare.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Shawn Davis
Chief Information Officer
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