Pharmacy Business Office Specialist (17510)

Job Summary:  

This position prepares, verifies, corrects, and submits electronic insurance claims, resolves complex billing issues, codes, and posts entries into Pharmacy patient accounting system to ensure accurate and expedient processing of general accounting, accounts payable, accounts receivable or other financial documentation. The position may require performance or supervision of clerical, receptionist or other business office related tasks.

Qualifications: 

• A high school diploma is required; a college degree or equivalent advanced courses in office management are preferred.
• Experience in a business office environment or hospital to include two (2) years of payment posting, billing and/or collections experience is preferred.
• Computer literacy is required.
• Proficiency in math and language usage is expected.
• Must be able to handle potentially stressful situations and multiple tasks simultaneously.
• Ability to read, write, and speak the English language is required.

Essential Functions:

The essential functions described below are representative of those an employee encounters while performing the basic functions of the position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. While every effort has been made to identify the essential functions of the position, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statement of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position. The Business Office Specialist is at a minimum responsible for the following functions, either directly or through delegation to qualified staff:

• Ensures patients are registered in Pharmacy patient accounting system and billed with appropriate payor type.
• Reviews claims for accuracy, performs required edits, submits claims and rebills to payors daily in electronic format to ensure accurate and timely filing of claims and prompt payment.
• Requests additional information from patients, insurance carriers, Pharmacy staff, and other Cantex departments to make corrections to claims.
• Receives and posts assigned payment batches to the appropriate patient account or facility account from checks or remittance advice using the appropriate payment/adjustment code to ensure accurate and timely posting of receipts
• Makes appropriate corrections such as changing payor types, updating payor information, and/or changing the priority of the payor accounts to ensure payments are posted accurately.
• Accumulates and provides data/documents for maintenance of accounts payable, accounts receivable and payroll ledgers.
• Prepares and delivers bank deposits.
• Compiles data and provides cumulative reports on a daily, weekly, or monthly basis as required by departmental Supervisor, Manager and/or Director of Pharmacy.
• Answer incoming calls in a timely manager.
• Maintains appropriate inventories of various office supplies and forms.
• Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact billing, collections, and payors.