General Summary

Under general supervision, inputs and reviews billing information; prepares reports, tables, graphs and interprets results; researches and reconciles billing problems according to policy and procedure. Interacts with patients when for billing purposes and authorizations. Performs administrative duties for the ambulatory pharmacies.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.Handles accounting support duties using established rule, regulation and general accounting practices and departmental procedure.

• Collects data from the retail pharmacy system on a regular basis from end-of-day reports for the end-of-month reporting and as needed.
• Collects and organizes internal and external payment vouchers and bills the appropriate insurance company or cost center.
• Performs reconciliation functions from accounts receivable, i.e. - third-party payments.
• Interacts with patients to discuss or resolve any billing issues.

Coordinates with pharmacy and clinical staff to minimize bad debt and increase revenue

• Proactively and retrospectively will work authorizations to ensure proper payment
• Investigate benefits and advise patients of potential payment options, including patient assistance programs, copayment programs, state assistance programs, etc.
• Educate pharmacy staff or clinical staff to minimize audit risk

Act as liaison to ITG and the pharmacy computer vendor

• Respond to computer problems and initiate calls to the helpdesk when the staff is unable to correct any errors in the system, which cause excessive downtime.
• Interacts with the pharmacy computer software vendor when assistance is needed which includes third-party setup and processing concerns, new formats and new opportunities.

Prepares and reviews a variety of written correspondence in accordance with departmental procedures.

• Receives and verifies statistical reports for completeness and accuracy.
• Reports prescription totals for each pay cycle to accounts receivable and pharmacy business manager.
  • Enhances customer relations through the use of the C2X standards ensuring a courteous and respectful environment for both internal and external customers.
  • Attends scheduled meetings and in-service training in order to provide professional development and growth.
  • Prepares and participates in audits from insurance companies to ensure billing compliance. Reviews them and will appeal as needed and work with leadership to re-educate the staff.
  • Performs related duties as required.