To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Provides a wide variety of billing, collections and business management services associated with the daily billing operation of the Specialty Pharmacy business to provide accurate and efficient Medicare Part B Billing to achieve our Quality and Financial goals. Responsible for Pharmacy Insurance data entry and verification of Medicare Part B, Commercial Insurance, and Medicaid. Must have knowledge of processing Insurance claims and be able to handle any incoming inquires form insurance providers, health system providers an/or patients.
- 1. Accurately process and prepare Medicare Part B billing and maintains documentation/information needed for claim. Corrects claims and re-files as needed to ensure proper payment , bills appropriate primary or secondary payor sources. Audits charges and confirm payment on Medicare Part B claims. Answers and resolves all incoming calls regarding prescriptions, establishes and maintains appropriate documentation needed to bill, packing slips, signature sheets and order forms.
- 2. Assists the pharmacist in all operational activities of the pharmacy in order to optimize customer satisfaction and maximize profitability of the pharmacy. The specific duties would include customer relations, computer and prescription filling, drug orders and inventory, marketing, accounting and any supportive tasks involved with workflow. Responsible for policies and Proceedures (as they pertain to operations, quality assurance, goals and priorities).
- 3. Customer Service- communicate with patients in a friendly, welcoming manner with greeting provided by management. Completion of updating accurate demographic information such as address, birthdate, insurance information and allergies. Provide appropriate waiting time via telephone or in person. Responsible for finding a patients insurance information if the patient is unable to provide. The "Service for Excellence" mission provided by YNHH is the main focus. Awareness of all of the "non-negotiables" (10/5 rule, no venting, library voices, AIDET and the Pledge to Service of Excellence).
- 4. Computer and prescription filling- demonstrates proficiency in cross-funtional areas of the department, including (but not limited to) QS/1, Mckesson ordering process, Epic, Therigy, Emdeon, Macro Helix, Employee Self Service and the DSS website. Responsibilities also include awareness of specific programs (MAP, Workers Comp, Columbus House, etc) and how to process prescriptions within these programs. Responsibility for regulatory awareness and reporting of medication errors.
- 5. Drug Orders and Inventory - accumulate information on prescription drugs needed. Validate inventory is in stock for prescriptions filled. Report any discrepencies to management and review weekly for prescriptions not picked up and return to stock every 14 days. Review backordered items to see if another source can be ordered.
- 6. Identification and qualification of patients eligible for medication patient assistance programs and foundations. Interfaces with program administrators for reimbursement assistance programs sponsored by the drug manufacturer. Tracks, documents, and reports out cost savings associated with patient assistance drug recovery programs and provides updates to pharmacy management. Provides manufacturer coupons to patients, if available.
- 7. Demonstrates knowledge of Medicare Part B claims, insurance company requirements and third party regulations related to Medicare. Ensures compliance with all HIPPA policies specifically relating to patient confidentiality and release of information. Performs in-services to staff and ancillary staff to keep them up to date with all the Medicare Part B processes and changes.
- 8. Develop, manage, and maintain various electronic documents used to manage and track projects and outcomes.Develop Standard Operational Procedures (SOP) related to Medicare Part B and cost saving initiatives.
Review CMS paperwork and prescriptions for accuracy and completeness prior to the medications go out to ensure proper payment.
High School Diploma or equivalent required.
Retail Pharmacy Technician experience preferred. A minimum of 3 years work experience in the healthcare field specifically in medical billing and collections preferred.
Excellent administrative and organizational skills. Strong accurate attention to billing and collections details. Must have excellent communication skills and the ability to prioritize and multitask/change tasks frequently and quickly. Knowledge of drug products preferred. Must have working knowledge of Medicare, Medicaid, third party insurance company guidelines and regulations. Strong computer skills with EMR experience a plus. Must have patient management expertise.
Office position, located in Hamden, full time weekday position with some Saturdays required.