Pharmacy Billing Specialist

CommuniCare Health Services

13h • Onsite

About The Position

The Indiana Virginia Pharmacy Solutions Group is currently recruiting Pharmacy Billing Specialists to join our team. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.

Requirements

• High School Diploma or GED required.
• Previous Medical Billing experience required.

Nice To Haves

• Framework knowledge is a plus.
• Pharmacy Experience/Background is a plus.

Responsibilities

• Completing Action Summary for assigned homes on a daily basis
• Census reconciliation on a weekly basis including Medicare. This includes: Verifying correct patient setup for monthly billing (i.e. validating Data set up correctly - MOP’s, Medicare Days, invoice group, customer group, address, allergies, mrn) Completing SQL Reports.
• Monitor and manage room moves and update in Framework.
• Begins rebill process based on payer changes.
• Primary Billing Batches worked in timely manner (2 to 3 days).
• Primary and Secondary Rebilling - Private Pay accounts, Medicaid approval, incorrect billing, etc.
• Communicate to management if Rebilling is not completed by the 9th of each month.
• Back up for daily deposit
• Back up for Hospice Med list and hospice rebilling
• Ensure assigned homes billed accurately and timely at month end. (LTC complete by 4th business day. Private pay residents billed by the 5th business day but no later than the 10th of each month.)
• Assist Accounts Receivable Analyst in the following: Customer Notes- answer family billing questions for assigned homes in timely manner. Monitor Medicaid Pending Group each month ensuring claims are rebilled once Medicaid approval is received. Send BAE on Medicaid Approved Residents when needed.
• Third Party Audits as requested by supervisor
• Assist with Training and QA (Quality Assurance)
• Running Daily MOP Verification Reports (Outside MEDA, MCR Changed to GUAR, Outside MCR Days, Posted MOP Report)
• Monthly Composite Batches
• Assist with other projects as assigned

Benefits

• Our employees enjoy competitive wages and PTO plans.
• We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers.
• We also offer 401(k) with employer match and Flexible Spending Accounts.

What This Job Offers

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