Summary
Prepares and submits pharmacy reports, monitors and expedites payments, initiates claims research and maintains ongoing communications regarding collections and open claims. Is accountable for preparation of bank deposit information and prepares and submits month-end balancing information to management. Reconciles vendor invoices and uploads files to Lawson for payment. The incumbent scans and mails remits to vendors.

Job Title: Pharmacy Billing Specialist II - HC

Hours: 40 Full-time

Location: RRH Home Infusion Therapy - 2975 Brighton Henrietta Townline Road, Rochester, NY

Department: Lifetime Care Billing

Schedule: Monday - Friday, day shift 8:30am-5pm   

Key Responsibilities
All Levels

• Reconciles vendor invoices and uploads files to Lawson for payment.
• Scans and mails remits to vendors
• Monitors the status of open pharmacy claims and takes appropriate action to expedite payments.
• Prepares files or paper claims for submission. Works directly with insurance carriers and provider representatives to facilitate payments. Maintains ongoing communications regarding collection problems and open claims.
• Applies and maintains a record (billing journal) of all pharmacy payments received. Accountable for preparation of bank deposit information related to assigned carriers. Also, prepares and submits month-end balancing information to management during a designated timeframe.
• Performs a variety of related duties such as developing reports to initiate the scrubbing of claims; prepares both files and paper depending on both system and carrier needs; applies payments, researches and resolves denials related to both carrier and clearing house issues.
• Constantly communicates with management in regards to problem accounts.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II – performs similar functions as level I, plus:

• Keeps management up-to-date on carrier changes and guideline requirements.
• Works directly with provider representatives and maintains ongoing communications regarding collection problems and open claims.
• Resolves billing problems, coverage issues and so forth via contracts and company websites.
• Solves difficult cases where coordination of benefits is an issue.
• Works with supervisor on research and resolution of denials related to clearing house issues.
• Reads and attends any informational sessions/bulletins where changes might be discussed and educate management in this regard.

Required Qualifications

• A.A.S. degree in Business Administration with concentration or emphasis in accounting and at least one year of related experience. In lieu of degree, a minimum of three years of appropriate education or training, and substantial directly related experience will be considered.
• Must possess strong written and verbal communication skills.
• Capable of establishing and maintaining constructive relationships with outside professionals, patients, and all levels of staff and management. Must professionally and effectively interact with patients regarding their account and insurance billing.
• Ability to handle confidential information with the utmost discretion and confidentiality.
• Proficient in Microsoft Office and PC skills.

Additional Job Description

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$19.00 - $24.00Rochester14623

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.