US Pharmacy Billing and Reimbursement Professional

1 day ago


Lahore, Punjab, Pakistan Sanabel Ventures Full time
Job Description

We are looking for an experienced professional to handle pharmacy billing and reimbursement tasks. The ideal candidate will have comprehensive knowledge of the pharmacy billing process, from start to finish, and will be responsible for ensuring timely, accurate billing and reimbursement for pharmacy-related services.

Key Responsibilities:

  1. Prescription Claim Submission: Process claims accurately for pharmacy services, including preparing and submitting claims to insurance companies.
  2. Insurance Verification & Prior Authorization: Verify patient eligibility and insurance coverage; obtain prior authorizations as needed for prescribed medications.
  3. Payment Posting: Accurately post payments from insurance companies, patients, and third-party payers.
  4. Accounts Receivable Management: Follow up on unpaid or denied claims, review Explanation of Benefits (EOBs), and work on appeals or resubmissions to secure payment.
  5. Denial Management: Analyze and resolve denied claims by communicating with insurance companies and third-party payers, ensuring full reimbursement.
  6. Compliance: Ensure adherence to all regulatory and payer guidelines, including HIPAA and CMS requirements.
  7. Reporting & Documentation: Maintain organized records of all billing activities, payments, and adjustments; provide reports on billing status and receivables.

Requirements:

  1. Experience: Minimum 2 years of experience in pharmacy billing or related healthcare billing.
  2. Knowledge of Pharmacy Billing Software: Proficiency in pharmacy billing systems and software (e.g., QS/1, PioneerRx, or similar).
  3. Insurance & Payer Knowledge: Familiarity with Medicare, Medicaid, and third-party payer requirements specific to pharmacy claims.
  4. Detail-Oriented: Strong attention to detail with a commitment to accuracy in billing, payment posting, and record-keeping.
  5. Problem-Solving Skills: Ability to analyze and resolve billing issues, including handling denials and working on appeals.
  6. Communication Skills: Excellent written and verbal communication skills, with the ability to effectively interact with insurance representatives, patients, and healthcare providers.
  7. Compliance: Knowledge of HIPAA regulations and other healthcare billing compliance standards.

Preferred Qualifications:

  1. Certification in Medical Billing or Pharmacy Billing (e.g., CPB - Certified Pharmacy Biller) is preferred but not required.
  2. Experience with pharmacy management software.
  3. Prior experience working in a retail or hospital pharmacy setting.

Benefits and Perks:

  1. Competitive salary.
  2. Flexible work environment.
  3. Opportunities for career growth and advancement.
  4. Supportive team culture.


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