Pharmacy Billing Technician

Great Plains Tribal Leaders Health • Rapid City, SD

7d • $23 - $29 • Onsite

About The Position

The Pharmacy Billing Technician performs a full range of pharmaceutical billing duties, including timely submission of pharmaceutical claims to third-party payers and responsible parties using the RPMS Pharmacy Point of Sale system. This role involves rebilling or correcting previously submitted claims, performing various clerical tasks, and assisting billing staff with unpaid pharmacy claims. The technician will also act as a POS technical resource, providing training and education to billing staff, and collaborating with pharmacists on formularies. Compliance with federal laws, HIPAA, and organizational policies is required.

Requirements

• Completion of a formal training program or an associate’s degree and one (1) year relevant experience; or, a high school diploma or GED and three (3) years of relevant experience.
• Ability to perform the essential functions of the job, with or without reasonable accommodation.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Must be able to read, write, speak, and hear.

Nice To Haves

• Tribal preference laws are followed, giving preference to qualified Indian/Tribal candidates over qualified non-native candidates if all other qualifications are equal.

Responsibilities

• Analyzes, maintains, and directs the operations for the pharmacy point-of-sale program.
• Approves, edits, and overrides pharmacy claims for the OHC in RPMS POS system.
• Researches, enters, and runs eligibility on new pharmacy insurance plans to RPMS using different insurance portals.
• Researches and verifies patient insurance for all pharmacy insurances when encountering errors during edit of claims in RPMS.
• Coordinates benefits, verifies data, and gives appropriate information to the PBC/PSR staff.
• Completes insurance data for patient claims; processes, researches, and corrects accounts; verifies diagnosis and authorization codes; identifies liability and guarantors; interprets Explanation of Benefits (EOBs); and analyzes billing components.
• Submits prior authorizations for all prescriptions requiring a prior authorization in the Pharmacy using Cover My Meds.
• Reviews all denied claims to determine if a claim was denied incorrectly.
• Answers questions from relatives, staff, and insurance companies.
• Runs, maintains, and monitors POS reports including STRANDED, MISS OPPORTUNITY, DUPE CLAIM REPORT, CORRUPTED REPORT monthly, notifying the business office manager of any trends or problems, notifies technicians of errors, and contacts third party providers when necessary.
• Runs a Before and After back bill report which generates rejected claims to be worked weekly.
• Runs a rejected claims report to be worked daily.
• Maintains accuracy in RPMS NDC’s and cost and removes any inactive NDC.
• Utilizes ScriptPro regularly to verify accurate NDC, dispense, mail, and research information for audits to provide proof of dispense.
• Assists Pharmacy Supervisors in the maintenance of the RPMS Pharmacy Drug Files in the computer system for billing purposes, such as updating NDC numbers and “re-matching” drugs to the National Drug File (NDF) when necessary.
• Handles all pharmacy audits including individual and desktop, maintains record keeping for 7 years This is to include researching, gathering information, creating reports Conducting internal audits to mitigate the risk of fraud.
• Answers all correspondence requesting information on provider or relative.
• Notifies supervisor of all claims deemed unbillable along with reason(s) on a daily basis.
• Serves as a POS technical resource, provides orientation, and provides ongoing training and education to billing staff.
• Works closely with pharmacists to collaborate on formularies.
• Maintains a list of uninsured relatives who routinely receive high dollar medications. This is shared with PBC to capture revenue if insurance changes.
• Maintains a list of high dollar medications that South Dakota Medicaid allows a resubmission above the all inclusive rate.
• Maintains a list with the pharmacist of relatives who have insurance that fill at outside pharmacies to prevent duplicate fills and potential adverse reactions.
• Attends monthly POS webinars to remain knowledgeable, ask questions, or keep up on new patches.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties as assigned.
• Performs the core responsibilities of the position accurately, timely, and in accordance with established standards.
• Maintains regular and reliable attendance consistent with the position’s schedule and operational needs.
• Communicates effectively with internal and external stakeholders as required by the role.
• Adheres to all applicable policies, procedures, and regulatory requirements.
• Utilizes required systems, tools, and technology necessary to perform the job.

Benefits

• Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree