Pharmacy Technician-Billing

Overview

Description

Job Details

Description

Closing Date: March 02, 2026 @ 4:00 P.M. (MST)

Salary Range: Dependent on Experience (DOE)

Requirements: APPLICANT MUST HAVE A VALID, UNRESTRICTED INSURABLE DRIVERS LICENSE; RESUMES AND REFERENCES ARE REQUIRED

• Reviews electronic records from outpatient services daily reflecting patient care provided and medication prescribed/dispensed.
• Receives the pharmacy prescription dispensing reports electronically via online billing system. Determines if the prescription written by the provider is billable as defined by FDIHB guidelines and inputs data into the system accordingly. Verifies prescription amount dispensed by reimbursement by Pharmacy Benefits Managers.
• Ensures that prescriptions dispensed are entered into the system with the correct brand name or generic name, as this information is the key to the charge generated per visit and maintained in the accounting records.
• Requests and obtains prior authorization for various pharmaceutical products from insurance companies. Receives and completes authorization forms providing all data required, obtains signatures, and returns as needed for processing of collection.
• Contacts the healthcare provider for additional information when services rendered to patient and prescription written for the patient are not clear, or when more details are needed to complete the forms for the episode of care.
• Retrieves medical records. Researches patient records, reconstructs incorrect or missing medical information required to prepare a valid insurance billing when data received is incomplete.
• Provides training to patient registration staff to assure that necessary data is entered into the registration package to identify insurance and benefits to start billing activities into the on-line billing system. Researches new insurance registrants for appointment history report to capture new and old billable visits. Calls insurance carriers to obtain overwrites for old visits.
• Analyzes, maintains, and directs the total billing operation for pharmacy point-of-sale programs, and acts as an advocate for FDIHB in the collection of Alternate Resources.
• Researches and follows-up on rejected claims online in order to ensure maximum reimbursement. Works with Pharmacy Benefits Manager help desks to fix rejections within specified time frames. Documents all information in the patient’s medical chart, RPMS, and online system package.
• Prevents occurrences for “orphan visits” by creating an administrative billing. Creates a pharmacy visit PCC, records diagnoses and services rendered, and re-enters into the online billing system for another attempt to recover collections. Follows up as needed to maximize amounts collected.
• Develops and maintains files for tracking billing and reimbursement. Initiates inquiries with insurance companies after pre-established time frames to determine why claims were rejected.
• Maintains records and files per regulations and guidance. Maintains documentation of actions for audit trails. Provides documents to insurance companies when requested for an audit.
• Maintains records of each claim billed, coordinates with Patient Accounts billing technicians, tracks amounts collected, adjustments, and final disposition.
• Maintains online billing accounts to ensure validity of patient charges. Maintains interface between billing software and RPMS system. Processes payments and liaises with collection Clerks.
• Maintains and updates Pharmacy Benefit Manager contracts. Works with designated personnel to obtain and track billing agreements.
• Serves as a technical resource for the online billing system, provides orientation and ongoing training to personnel.
• Responds to third party requirements on post-payment reviews, exclusions, denials, and appeals. Performs audits and medical reviews to ensure documentation and accountability on health insurance claims.
• Performs qualitative and quantitative analysis on medical records to ensure proper documentation and compliance with regulations.
• Reviews, interprets, and accurately fills prescriptions, and demonstrates working knowledge of RPMS Pharmacy Package and hospital computer system.
• Demonstra…