Pharmacy Tech/Biller

Kaweah Delta Health Care District•Visalia, CA

37d•Onsite

About The Position

Under the direct supervision of the Pharmacist, the Pharmacy Technician will perform assigned tasks, within their scope, necessary for the operation of the pharmacy. This role involves both technical pharmacy duties and patient financial services, including billing, insurance verification, and maintaining patient records. The position requires a strong understanding of pharmacy operations, billing procedures, and payer guidelines to ensure accurate reimbursement and compliance.

Requirements

Pharmacy Technician registration with the California State Board of Pharmacy
High school diploma or equivalent
One year pharmacy technician experience

Nice To Haves

Certification as a Pharmacy Technician

Responsibilities

Keeps the pharmacy organized and clean.
Maintains a friendly service-based attitude and work environment.
Constantly strives to improve processes, productivity and quality.
Keeps other staff apprised and informed, assists in training and mentoring.
Keeps the Outpatient Pharmacy Manager informed of any potential issues or areas of concern on an ongoing basis.
Answers telephone with courtesy, takes messages as required, and refers technical/clinical problems to the Pharmacist as appropriate or required by law.
Participates in Pharmacy staff meetings, training, and ongoing education.
Self-reports medication errors.
Maintains knowledge of compounds and medications given by the pharmacy.
Maintains knowledge of KDHIP, CHC (SNF Medi-cal billing) and Medicare Part D billing.
Establishes and maintains patient charts, documentation, logs and files.
Inputs information into computer, generates and uses reports to ensure smooth workflow of the pharmacy billing.
Obtains TARs and SARs for billing the Medi-cal and CCS payers.
Generates bills from computer system to bill payers.
Maintains complete and full knowledge of payer(s) assigned to ensure compliance of specific guidelines and rules, as well as ensuring Kaweah Health is being reimbursed by the payer in accordance with governmental or contract terms.
Acts as a resource to Finance division management regarding the assigned payer.
Brings any reimbursement or compliance concerns to the attention of the Manager.
Utilizes computer systems and/or billing reports to review all patient registrations or admissions for demographic information, appropriate financial class, insurance company and plan and charges.
Audits unbilled reports for potential holdups of patient accounts.
Works closely with pharmacy staff on DIF issues, insurance authorizations and documentation needed for billing.
Completes billing process.
Ensures all charges are accurate and appropriate.
Follows up in a timely manner with appropriate payers to ensure payments will be received.
Reviews and researches patient account credits and refunds as appropriate to patient and/or payer.
Receives all correspondence and inquiries related to patient accounts and payer contracts for which they are responsible.
Answers mail and takes appropriate action within specified timeframe.
Bills any secondary payers, changes insurance plans or financial class accordingly and sends appropriate information to the secondary payer for co-pays, deductibles or denied services.
Reviews and works aging reports to identify any unpaid accounts.
Works to ensure that days in accounts receivable are met, maintained and/or lowered.
Maintains job productivity and quality standards on a consistent basis as established by division management.
Performs intake of patient to Home Infusion services.
Validates insurance and obtains insurance authorization when required initially and ongoing.
Informs patients of financial responsibilities prior to providing Home Infusion services.
Coordinates initial and ongoing services with physician, nursing services, pharmacy services and patients.
Coordinates and provides documents and information to Patient Accounting services for billing and authorizations.
Works with Pharmacists to maintain current census.
Assists the Pharmacist in providing effective, appropriate, and safe pharmacy services.
Recognizes situations that exceed technician authority (e.g. drug information, pharmacist checks, etc.) and refers to pharmacist for follow-up and resolution.
Always obtains pharmacist verification prior to dispensing medications to customers.
Assists customers and keeps them apprised in processing prescriptions, billing, sales, pick-ups, mail outs, and payment collection if necessary.
Assists the pharmacist in preparation of prescriptions within the scope allowed by California State Board of Pharmacy, Federal Law, and Kaweah Health Policies.
Processes prescriptions through the Pharmacy Information System.
Appropriately submits claims to insurance/payers.
Contacts and follows up to physician offices for refill request and inquiries.
Maintains the database for the Information System including addition of new medications, pricing updates, physician database, back-ups, software updates, etc.
Performs end of day processing under the supervision of the Pharmacist-in-Charge (PIC) and Outpatient Pharmacy Manager.
Provides reporting and audits when requested.
Consistently documents refrigerator temperatures as part of established pharmacy policies and procedures.
Assists the PIC in control substances perpetual inventories and CURES reporting.
Maintains records, logs and prescriptions as mandated by State and Federal Laws and Regulations and Kaweah Health Policy under the supervision of the PIC.
Responsible for deposits of monies/checks to Patient Financial Services per Kaweah Health policy.
Responsible for end of day and end of month reconciliation of funds with the Point of Sales (POS) systems in use at the Pharmacy, including all types of payments.
Under the supervision of the PIC, helps manage inventory and returns.
Acts upon recall notices immediately.
Orders pharmaceuticals for dispensing and pharmacy supplies.
Orders contracted items and utilizes cost effective generic medications when applicable.
Removes outdating unusable medications for return or disposal.
Performs annual physical inventory per Kaweah Health policy.
Assures medication stock is rotated when new orders are received and placed on the shelf.
Performs pharmacy deliveries as part of the meds-to-beds program.
Performs other duties as assigned.