Pharmacy Billing Coordinator (Pharmacy Technician Required)

San Ysidro Health Center-posted about 2 months ago
Full-time • Entry Level
San Diego, CA
Religious, Grantmaking, Civic, Professional, and Similar Organizations
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The Pharmacy Operations department provides a variety of services and customized patient care to help manage patients' medication needs. The Pharmacy Operations team works with patient's insurance companies, submits prior authorization requests, patient assistance program applications and assists in-house pharmacies addressing patient requests. The Pharmacy Billing Coordinator will be responsible for completing claims reviews, reconciliation of claims, and Pharmacy Benefit Manager (PBM) payments posting.

  • Reviews patient HER and prescription data in the pharmacy system.
  • Reviews claim submission for accuracy.
  • Review and Posts payments in Pharmacy Benefit Manager portal.
  • Downloads 835 files from Pharmacy Benefit Manager portal.
  • Organizes and uploads 835s to EPIC File Transfer Protocol (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.
  • Removes 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.
  • Reviews and submits prior authorizations as needed.
  • Performs other related duties as assigned by the Director of Pharmacy and/or Pharmacy Business Services Supervisor.
  • High School Diploma or GED equivalent. Completed of a Pharmacy Technician Program.
  • Minimum of 2 years of Pharmacy Technician experience in a retail setting with claim adjudication/billing experience.
  • In date, Pharmacy Technician license from CA board of Pharmacy.
  • Bi-lingual (English /Spanish speaking) preferred.
  • Excellent oral and written communication skills.
  • Ability to organize and prioritize work to meet deadlines.
  • Ability to follow directions correctly and accurately.
  • PC, Microsoft Suite and Pharmacy Software System (EPIC).
  • Prolonged periods of sitting using a PC.
  • Lifting no more than 15 lbs.
  • Driving and occasional travel to other sites may be required.
  • 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.
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