Pharmacy Billing Associate

Grane Rx•Pittsburgh, PA

4d•Hybrid

About The Position

Our Billing Associate work internally with the Billing and Accounting Team, Pharmacist and Order Entry, and Production Teams. The Billing Associate works externally with Customers, and Third Party Insurance Personnel. Over 30 years, Grane Rx has been an industry leader, revolutionizing long-term care pharmacy solutions and services. The company focuses on caring for thousands of assisted living and nursing home residents along with onsite clinical consulting and training. Long Term Care and PACE pharmacy solutions from Grane Rx are currently available in four states.

Requirements

High School diploma required.

Nice To Haves

Bachelor’s degree is preferred
1-5 years of LTC Pharmacy and billing experience preferred
Certified Pharmacy Technician

Responsibilities

Data entry and review of patient demographics
Correspond with facility and family representatives to gather demographic information for the purpose of validating appropriate charges to facility and/or private pay accounts.
Perform daily tasks as assigned.
Adhere to Grane Rx billing and denial management processes and procedures.
Review and process Medicaid pending claims.
Perform daily census reconciliation procedures to ensure census data is in alignment with facility census information
Perform comprehensive census reconciliation procedures to ensure that census data is correct.
Perform hospice reconciliation procedures to ensure hospice data is accurate
Process Third Party Claims
Perform necessary rebills and credits as needed
Produce month end and interim reports.
Review of facility pre-bills to ensure accuracy.
Review of facility invoices and rebill claims as necessary.
Assist with prior authorization and non-formulary worksheets and process.
Triage of documents to appropriate work queues.
Ability to handle outbound and inbound phone calls from customers.
Assists with the preparation of Third Party Payors (PDPs) audits.
Duties as assigned.