Pharmacy Billing Analyst - Full Time Day Shifts - Bingham Farms

Join Henry Ford Health as a Full Time Pharmacy Billing Analyst and make an impact on the Ambulatory Pharmacy department.

GENERAL SUMMARY:

Schedule: Full Time Day shits - 40 hours a week

Location: Bingham Farms

Under minimal supervision, is responsible for resolving pharmacy adjudication rejections, as well as explaining COB related questions. Responsible for identifying and determining the accuracy and completeness of patient financial, insurance and demographic information, ensuring compliant claims to Third party payers, in accordance with established policies and procedures, as well as providing pharmacy support.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Accepts customer calls and provide accurate, satisfactory answers to their queries and concerns
• De-escalates situations involving dissatisfied customers offering assistance and support
• Accepts and processes all patient account payments.
• Provides support to internal and external customers regarding pharmacy copays, claim rejections, rebills, etc.
• Verifies patient insurance coverage and makes necessary changes in pharmacy system.
• Troubleshoots and resolves claim adjudication rejections for patients, physicians, pharmacies, and internal staff.
• Responds to insurance audits and claim reversals on behalf of all pharmacy sites, taking the proper steps to resolve receivables as a result of audit outcome.

• Identifies and resolves credit balances and understand the impact on patient responsibility and third party refunding.

• Evaluates and investigates claims on various reports to ensure proper billing and COB at pharmacy level.
• Submits third party medical and/or CMS1500 claim forms through the claims editing software. Understands the claim editing process and resolving the edits based on department procedures regarding claims submission.
• Converts pharmacy drug quantities into Medicare billing units according to Medicare Guidelines prior to submitting medical CMS1500 claim forms.
• Evaluates and investigates appropriation to be taken to submit automotive and worker's compensation claims, which includes verifying COB and billing demographics.

• Manually generate invoices and submit to each participating nursing home of the First Fill Program, following the evaluation of the proper billing and appropriation to bill all claims correctly.

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.