Pharmacy Technician-Billing

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

Salary Range: Dependent on Experience (DOE)

** 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, for 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 to the facility. Works with the various Pharmacy Benefits Manager help desks to fix rejection within specified time frames. This includes telephone contacts and any steps necessary for satisfactory resolution of the claim. Documents all information in the patient’s medical chart, RPMS, and online system package.
• Prevents occurrences for ‘orphan visits’, by means of creating an administrative billing. Creates a pharmacy visit PCC, a record source document used to record patient’s diagnoses and services rendered, and reentered into the online billing system for another attempt to recover collections due the facility. Follow up as needed to ensure maximum allowable amounts are collected.
• Develops and maintains files for the tracking of billing and reimbursement. Initiates inquiries either telephonically or by any viable means of written correspondence with insurance companies after pre-established time frames in order to determine why claims were rejected.
• Maintains records and files in accordance with applicable regulations and guidance. Responsible for maintenance of general files of directives, instructions, regulations, notices and correspondence related to Pharmacy Benefits Manager programs. Ensures there is documentation of all action(s) taken for adequate audit trails. Provides documentation to the insurance companies when requested for an audit.
• Maintains records of each claim billed detailing history, noting what action was taken on each claim; and coordinates with Patient Accounts billing technicians to record the amount collected and percentage paid; the amount resolved as invalid billings; and the final account disposition.
• Maintains online billing accounts to ensure validity of patient charges which constitute the major portion of the hospital accounts receivable. Reimbursements from these accounts are budgeted as a portion of the hospital operating fund. Maintains the interface between the various…