Pharmacy Billing Coordinator
University of Massachusetts Medical School

Shrewsbury, Massachusetts

Posted in Education and Training


This job has expired.

Job Info


Overview

Under the direction of the Program Director of Public Provider Reimbursement, thePharmacy Billing Coordinator is responsible for coordinating and performing daily operations to support reimbursement activities for pharmacy services across the department. Activities include submitting pharmacy claims in accordance with coverage criteria to Medicare D Prescription Drug Plans (PDPs) and providing ineligible Medicare D pharmacy service data to various internal stakeholders within the Department to seek reimbursement from other liable payers.

Responsibilities

* Coordinate workflow and perform daily operations of program area, including assignment of tasks and distribution of work to meet all required deadlines. Daily operations include uploading service files and other data inputs into billing system, reviewing claims data, submitting claims, and distributing reports.* Prepare, review, and analyze claims data and reports including prior to submission of claims to liable payers. This includes resolving any discrepancies, invalid or incomplete data.* Responsible for quality assurance activities of all manual or exception service data entries or claim corrections into the processing system, including credits, adjustments, and claim reversals due to patient or drug redeterminations or payer rejections.* Conduct quality review of reports prior to distribution to clients and stakeholders ensuring accuracy and completeness.* Providing recommendations to clients for the resolution(s) of claim rejections or denials. Reprocess any claim rejections or denials in accordance with any clinical clarification that has been provided including but not limited to prior authorizations.* Ensure claims are adjudicating properly in relation to claim requirements. Claim requirements specific to this program area include Drug identification, Drug pricing, Third Party Liability, Member identification, Pharmacy Provider identification, Prescriber identification, and Drug Use Review edits.* Proactively monitor and research trends in service data or other related inputs, rejections, or denials for the purpose of identifying any systemic problems requiring changes to policies and procedures or billing system to prevent future Issues.* Distribute reports to clients and stakeholders.* Consult as necessary with clients and clinical peers to address or resolve questions or issues related to claims data.* Respond to payor and department audit reviews or requests.* Ensure provider compliance with regulations and policies as well as departmental policies.* Participate in hiring and training of pharmacy staff to ensure high quality and timely work.* Preserve confidential, protected health and personally identifiable information and files.* Perform related duties as needed and as assigned.

Qualifications

REQUIRED EDUCATIONPharmacy Technician State and National Certification (PTCB) REQUIRED WORK EXPERIENCE3-5 years of retail or long-term care pharmacy experience, medical billing other related experience.Strong organizational skills and proven ability to prioritize and coordinate multiple tasks and meet deadlines.Strong analytic skills and proven competence in independent problem solving.Strong customer service skills and attention to detail.Strong verbal and written communication skills.Excellent computer knowledge and skills in Microsoft Office suite.PREFERRED WORK EXPERIENCEPharmacy billing and claims experience.Pharmacy billing systems knowledge.Third party insurance experience.

Additional Information

- Position is 100% remote (South St. is the UMMS address), although occasional in person meetings may be required in the future when it is safe.  Training and meetings will be conducted via Zoom or Teams.

- COVID vaccine and booster required.


This job has expired.

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