![Sanabel Ventures](https://media.trabajo.org/img/noimg.jpg)
Pharmacy Claims Processor with Experience
1 day ago
About the Role
We are seeking an experienced Pharmacy Billing Specialist to join our team at Sanabel Ventures. As a key member of our team, you will be responsible for managing pharmacy billing and reimbursement processes, ensuring accurate and timely billing, and maintaining compliance with regulatory and payer guidelines.
Key Responsibilities:
- Pharmacy claim submission: Process claims accurately for pharmacy services, including preparing and submitting claims to insurance companies.
- Insurance verification and prior authorization: Verify patient eligibility and insurance coverage; obtain prior authorizations as needed for prescribed medications.
- Payment posting: Accurately post payments from insurance companies, patients, and third-party payers.
- Accounts receivable management: Follow up on unpaid or denied claims, review Explanation of Benefits (EOBs), and work on appeals or resubmissions to secure payment.
- Denial management: Analyze and resolve denied claims by communicating with insurance companies and third-party payers, ensuring full reimbursement.
- Compliance: Ensure adherence to all regulatory and payer guidelines, including HIPAA and CMS requirements.
- Reporting and documentation: Maintain organized records of all billing activities, payments, and adjustments; provide reports on billing status and receivables.
Requirements and Qualifications:
- Experience and expertise: Minimum 2 years of experience in pharmacy billing or related healthcare billing, along with proficiency in pharmacy billing systems and software.
- Attention to detail: Strong commitment to accuracy in billing, payment posting, and record-keeping.
- Problem-solving skills: Ability to analyze and resolve billing issues, including handling denials and working on appeals.
- Communication skills: Excellent written and verbal communication skills, with the ability to effectively interact with various stakeholders.
- Preferred qualifications: Certification in Medical Billing or Pharmacy Billing (e.g., CPB - Certified Pharmacy Biller) is preferred but not required, along with experience with pharmacy management software and prior experience working in a retail or hospital pharmacy setting.
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