Pharmacy Billing Specialist - Delhaize America
Location: Scarborough, Maine
Description: Delhaize America is looking of Pharmacy Billing Specialist - Delhaize America right now, this job will be placed in Maine. For detail informations about this job opportunity kindly see the descriptions. Job Title: Pharmacy Billing Specialist
Job Location: Scarborough, ME
Rebills denied Medicaid, state programs and private insurance plans for al! l banners within Delhaize America (Hannaford, Sweetbay, Food Lion, and Harvey's) and Independent pharmacies to increase collections/minimize write-offs.
Position Responsibilities:
- Acts as a resource to all retail and corporate associates in regards to third party billing.
- Notifies pharmacists of problems and provides resolution to ensure collection of payment and avoids error(s) on future claims.
- Ensures properly reported records in A/R system (Spectrum) and pharmacy systems (PDX /EPS)
- Works with third party insurers to resolve claim issues.
- Rebills denied, retroactive and aging claims online via PDX/EPS or manually via written letters, Universal Claims Form or HCFA 1500 form.
- Provides third party phone support to retail pharmacies.
- Communicates issues and insurance changes to pharmacy retail associates while maintaining a good working relationship.
- Assists Pharmacists/Technicians in! problem resolution by using various sources: Internet, billin! g manuals, insurance company contacts, PDX/EPS and Spectrum history.
- Maintains current knowledge of PDX, EPS and Spectrum as it relates to third party billing.
- Maintains current knowledge of multiple state Medicaid programs and hundreds of private third party plans' rules and billing regulations.
- Responds to incoming email, mail, faxes and phone inquiries.
- Provides answers and support to department Accounting Rep and Supervisor Pharmacy Receivables Accounting.
- Provides support to levels of retail/corporate (department associates, Rph, technicians, store managers, bookkeepers, operations managers, training specialists, pharmacy central and customers) with regard to third party billing questions, manual claims, over-shorts.
- Develops and maintains excellent working relationships with team, insurance representatives, retail associates and all levels of the Pharmacy team.
- Maintains knowledge of current diagnosis and ! procedure codes.
- Reviews and corrects manual claim forms submitted from retail, ensures accuracy - completing over/shorts when necessary.
- Properly manages errors on claim reversals and split-bill claims.
- Researches unapplied payments and resolves appropriately with the insurance company and in Spectrum.
- Manages weekly DME claims.
- Follows all HIPAA rules and regulations as directed by supervisor/department manager.
Qualifications:
- High school diploma or equivalent.
- Pharmacy technician with PDX/EPS experience or equivalent experience.
- Knowledge of third party billing procedures.
- Excellent written and oral communication skills.
- Ability to work well with others in a team environment as well as independently.
- Ability to identify billing issues and communicate to supervisor and team.
- Excellent analytical, math and problem solving ! skills.
- Knowledge of Word, Excel, email and Internet preferred! .
- Completed/Ability to complete Level 1 HIPAA training.
- Keeping abreast of quickly changing policies for hundreds of insurance plans including Medicaid in multiple states
- Identifying issues quickly and notifying key issues to the supervisor and team so procedures can be monitored and changed when necessary
- Rebilling claims within legalities to prevent insurance fraud and collect payment while maintaining accurate billing records in PDX/EPS and Spectrum
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If you were eligible to this job, please send us your resume, with salary requirements and a resume to Delhaize America.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job will be opened on: Thu, 07 Mar 2013 12:28:53 GMT
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