Pharmacy Billing Coordinator II

Company Description

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System’s anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

Job Description

Job Summary

The Pharmacy Billing Coordinator I inputs and reviews billing information; prepares reports, tables, graphs and interprets results; and researches and reconciles billing problems in accordance with policy, procedure, and regulations; works with the health care team to ensure that patients can obtain authorization for treatments by utilizing and interpreting clinical information to complete authorizations and patient assistance program enrollments; completes complex insurance reconciliations when needed; manages and completes audits and payor requests ensuring that specialty patients have the necessary financial coverage and authorizations for both pharmacy and medical infusion treatments to begin, maintain, and complete treatment.

Specific responsibilities will be documented and retained internally by the Department of Pharmacy.

Primary Responsibilities

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 responsibilities performed.

• Works to maximize optimum pharmacy revenue through pharmacy authorizations, appeals, and pharmacy claim reconciliation via customer and insurance payments.

• Communicates with insurance companies and health care providers and teams to ensure that patients have access to medications through optimizing insurance payments, coordination of benefits, copay assistance, and financial and patient assistance programs.

• Investigates and addresses insurance issues including but not limited to billing issues and/or pharmacy authorizations on behalf of providers

• Extensive knowledge of medical and pharmacy (including Medicare and specialty billing).

• Perform all other duties as assigned.

Qualifications

Education & Experience - Required

• High School Graduate or equivalent

• 5 years experience

• Pharmacy Leadership and/or specialty pharmacy and/or billing experience

• Maryland Technician Registration OR Medical Assistant License

Education & Experience - Preferred

• Some college

• National Certification (CPhT)

Knowledge, Skills, & Abilities

• Prioritizes work responsibilities and manages multiple demands.

• Demonstrates an awareness of self-responsibility and accountability for own professional practice.

• Adheres to all best practice standards and guidelines within the scope of professional practice and follows all hospital policies, procedures, and guidelines.

• Maintains competency in work- and pharmacy-related technology and applications and supports orientation and/or training of team members when appropriate.

• Seeks validation of knowledge base, skill level, and decision-making as necessary and assertively seeks guidance in areas of question.

• Practices effective problem identification and resolution skills as a method of sound decision-making. Accepts change as a part of the problem-solving process.

• Demonstrates effective communication methods and skills, using lines of authority appropriately.

• Enhances professional growth and development through participation in educational programs, current literature, workshops, in-service meetings, etc.

• Identifies the extent of the health system’s adherence to best practices and guidelines relevant to medication management.

• Attends hospital and departmental meetings as required.

• Utilizes appropriate customer relations skills when interacting with patients, their families, visitors, team members, and others, to ensure all customers are treated with respect and dignity.

• Represents the department on hospital committees, professional associates, and community organizations where appropriate.