Pharmacy Billing Coordinator

San Ysidro Health • San Diego, CA

4d • Onsite

About The Position

Responsible for review, interpreting and posting of Pharmacy Benefit Manager payments. Payment posting is a data entry position in a high production-based environment with time sensitive deadlines. Accurate application of payments is needed and attention to detail.

Requirements

• High School Diploma or GED equivalent.
• Minimum 2 years with claim adjudication/billing experience.
• Ability to organize and prioritize work to meet deadlines.
• Good oral and written communication skills.
• Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.
• Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

Nice To Haves

• Current Pharmacy Technician license from CA Board of Pharmacy preferred.
• 2 years of relevant medication prior authorization experience preferred.
• At least some familiarity with EPIC.
• Bilingual (English/Spanish preferred.
• Knowledge of MediCal, Medicare and commercial insurance regulations preferred.
• Knowledge of medical terminology and familiarity with Epic systems preferred.

Responsibilities

• Reviews patient and prescription data in the pharmacy system.
• Reviews claim submission for accuracy.
• Review and Post payments in Pharmacy Benefit Manager portal.
• Verify Deposits in Pharmacy Benefit Manager portal.
• Download 835 files from Pharmacy Benefit Manager portal.
• Organize and upload 835s to Epic FTP folder.
• Load and post bank cash files.
• Performs accurate posting of payments and denials.
• Applies adjustments according to carrier’s adjudication and/or SYH posting procedures and contracts.
• Reviews and clears errors on payments.
• Coordinates the preparation of reports and written documentation, as required by the department.
• Follows established departmental policies and procedures, quality assurance program, safety, environmental and infection control standards.
• Enhance professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
• Review and submit prior authorizations as needed.
• Performs other related duties as assigned by the Director of Pharmacy or Pharmacy Business Supervisor.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED