Pharmacy Medical Billing Specialist

Onco360•Louisville, KY

1h•Onsite

About The Position

Onco360 Pharmacy is hiring a Pharmacy Medical Billing Specialist at its Louisville, Kentucky location. The position is responsible for end-to-end billing of company-specific IV and oral therapies using the pharmacy platform, currently CPR+. The role reports to the Billing Manager and requires working knowledge of HCPC coding, ICD-10, J-codes, CPT, and NDC-specific claim billing. The specialist researches billing policies and procedures across payer types, processes and quality-checks claims, follows payer-specific guidelines, conducts billing follow-up, and maintains accurate patient and billing records. The role includes communicating with insurers, healthcare providers, and patients to resolve claims, prepare redeterminations and appeals when needed, and respond to patient billing and accounts receivable inquiries. The specialist must follow applicable company policies, compliance requirements, laws, and professional standards, work within deadlines, and be open to overtime when needed.

Requirements

High school diploma or GED.
1–3 years of medical or specialty pharmacy infusion billing experience.
Excellent interpersonal skills and ability to work with all levels of management and staff, both technical and non-technical.
Strong independent decision-making abilities.
Ability to conduct research and be resourceful and self-reliant.
Excellent communication and negotiation skills; persistence and persuasiveness.
Strong work ethic and excellent time management skills.
Ability to work independently and collaboratively in a group setting.
Detail-oriented, with proficiency in prioritizing workload.

Nice To Haves

Associate degree or higher in a related field.
Three or more years of experience in specialty pharmacy and/or infusion billing.
PTCB/CPhT certification.

Responsibilities

Research proper billing policies and procedures for all payer types and ensure claims are processed in accordance with industry and government standards and regulations.
Follow company compliance, integrity, patient privacy, and ethical billing practices.
Manage and process claims for all confirmed Ready to Bill tickets, performing quality assurance to ensure accurate and timely electronic claims and paper invoicing.
Review delivery tickets for accuracy and complete claims according to payer-specific guidelines.
Identify patterns of non-compliance by branch staff in completing patient registration, supporting documentation, and delivery tickets.
Process confirmed tickets within 24 hours of confirmation.
Notify the benefit verification team of demographic changes to reduce rejections of submitted electronic and paper claims.
Manage funding-related billing follow-up and act as a liaison to the Onco360 Advocate team.
Read and interpret EOBs and payer or insurance correspondence.
Use the company billing software platform efficiently and maintain accurate, detailed patient and billing notes to support claim documentation and collection.
Communicate verbally and in writing with insurance companies, healthcare providers, and patients to process and appropriately pay claims, including creating redeterminations and appeals when necessary.
Work with electronic claim adjudication, NCPDP 5.0 standards, and rejections; complete claim updates and corrections as needed.
Assist patients with billing and accounts receivable inquiries, including copay structure questions and accepting patient payments.
Meet specified deadlines and be open to overtime when necessary to meet department goals and objectives.
Perform other tasks as assigned.
Conduct job responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.