Pharmacy Business Coordinator - Infusion - Billing & Revenue Cycle
Job in
Morgantown, Monongalia County, West Virginia, 26501, USA
Listing for:
West Virginia University Hospital, Inc
Full Time
position
Listed on 2026-01-12
Job specializations:
-
Healthcare
Healthcare Administration, Medical Billing and Coding
Salary/Wage Range or Industry Benchmark: 60000 - 80000 USD Yearly
USD
60000.00
80000.00
YEAR
Job Description & How to Apply Below
Position: Pharmacy Business Coordinator - Home Infusion - Billing & Revenue Cycle
This position is responsible for conducting payer discussions, in‑house financial audits, payer performance compliance, prepayment claims audit, CMS CERT audits, CMS Fraud, Waste, & Abuse audits, and auditing third‑party payer compliance. They must maintain knowledge of revenue cycle operations, third‑party reimbursement procedures & regulations, payer relations, claims adjudication, contractual claims processing, medical terminology, and an understanding of the 340B Drug Discount Program.
Knowledge will include at minimum all aspects of payer relations, claims adjudication, contractual claims processing, and general reimbursement procedures. Provides customer support and resolves problems that may arise as a result of customer inquiries. Supports the work of the department by completing reports and performing clerical duties as needed. Responsible for performing pharmacy‑related functions in compliance with departmental policies and procedures that provide optimal pharmaceutical care.
Additionally, the Pharmacy Business Coordinator may be responsible for securing registration data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre‑certification, authorization, and third‑party claims management. Interviews patients and arranges alternate methods of payment. Ability to calculate patient co‑payments and deductibles based upon benefits processing.
MINIMUM QUALIFICATIONS
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:Associate’s Degree AND One (1) year of healthcare‑related experience
High School Diploma or Equivalent and Nationally Certified Pharmacy Technician (PTCB or EXPT) upon hire AND Two (2) years of healthcare‑related experience
PREFERRED QUALIFICATIONS
EDUCATION, CERTIFICATION, AND/OR LICENSURE:PTCB Advanced Pharmacy Technician CertificateEXPERIENCE:Three(3) years working in a specialty pharmacy.CORE DUTIES AND RESPONSIBILITIES
Drafts various correspondence letters and sends to referral source when necessary.Gathers and documents demographics, insurance information, needs assessment, and other data as needed.Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested.Identifies all patients requiring pre‑certification or pre‑authorization at the time services are requested or when notified by another hospital or clinic department.Enters pre‑registration using the comprehensive data elements into the registration/billing.Contacts insurance company or employer to determine eligibility and benefits for requested services.Performs medical necessity screening as required by third‑party payers.Identifies managed care admission/treatment requirements and assures the requirements are met to guarantee payment of the account.Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self‑pay portions.Communicates with the patient the anticipated self‑pay portion (co‑payments/deductibles/co‑insurance) and establishes payment arrangements based on the Financial Policy and documents the financial resolution in the registration/billing systems.Maintains current knowledge of major payor payment provisions and regulations.Maintains registration accuracy threshold of 98% as identified in audit processing.Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.Attends departmental meetings and/or documents review of meeting minutes.Participates in quality activities as assigned by Specialty Pharmacist Manager.Participates in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to coordinator or manager).Maintains confidentiality according to policy when interacting with patients, physicians, families, co‑workers and the public regarding demographic/clinical/financial information.Communicates problems hindering workflow to management in a timely manner.Demonstrates the knowledge and skills necessary to communicate to…
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