National Billing Specialist

SPS McKesson Specialty Prescription Services Corporation; Calgary; On-site; CAD 50,000 - 70,000; Full time

Job summary

A leading company in pharmacy services is seeking a National Billing Specialist in Calgary. This role is pivotal in managing billing operations, ensuring compliance with pharmacy standards, and optimizing revenue opportunities. Applicants should possess strong communication and teamwork skills, with a background in pharmacy billing and an understanding of reimbursement practices.

Benefits

Competitive compensation package

Annual bonus opportunities

Qualifications

• 3+ years of pharmacy Kroll billing experience with a high degree of accuracy.
• Understanding of provincial public and private reimbursement.
• Strong communication and teamwork skills.

Responsibilities

• Oversee billing errors for the Pharmacy team and perform monthly reporting.
• Review pharmacy billing operations and ensure compliance with standards.
• Collaborate with departments to support pharmacy initiatives.

Skills

Communication

Teamwork

Problem-Solving

Relationship Management

Education

Grade 12 high school diploma or equivalent

Tools

Kroll

Microsoft Office

Job description

The National Billing Specialist is responsible for delivering yearly pharmacy commercialization targets and achieving required performance objectives. The Billing Specialist will be responsible for overseeing the billing errors for the Pharmacy team, monthly reporting to our clients, and keeping our accounts receivables at an acceptable range for the billings done by the team. They will also act as a liaison between the billing team, pharmacy team, manufacturer clients, and patient support program as needed.

Specific Responsibilities generally include but are not limited to the following

• Review the pharmacy transactional data nationally and enhance billing policies and practices.
• Performing day-to-day pharmacy billing operations, month-end reports / billing reports, reviewing and submitting claims
• Find and assess opportunities to perfect billing.
• Be up to date on the pharmacy reimbursement landscape for drugs under the McKesson portfolio.
• Be up-to-date with the pharmacy reimbursement landscape nationally, across all provinces.
• Forecast trends based on the reimbursement landscape.
• Perform quality audits of pharmacy billings nationally to ensure compliance with Pharmacy standards of practice, provider agreements, and billing policies.
• Following up with patients and various payors for commercialization efforts
• Follow up with manufacturer, patient support programs, patients, or adjudicators on outstanding pharmacy claims.
• Review margin analysis of prescriptions billed nationally to detect payor changes and reduce any margin erosion.
• Extract reports from Kroll for the purposes of manufacturer billing
• Collaborate with other departments internally to educate and execute pharmacy initiatives.
• Ability to track and trend and use a variety of tools such as Microsoft Office or web-based tools for the purposes of reporting and tracking.

General Responsibilities

• Ensure company policies and standards are at the foremost of all activities and decisions.
• Participate in regular meetings to ensure that KPIs are being met.
• Troubleshooting complicated claims
• Analyze reimbursement-specific data and prepare reports for upper management and clients.
• Summarize consolidated financial results and provide input on the team’s fiscal year goals.
• Develop and maintain professional relationships with healthcare professionals, reimbursement coordinators, and insurance providers / adjudicators.
• Manage and maintain Gross Margin Report – to track pharmacy billing errors.
• Seek out opportunities to improve and increase revenue.
• Ensure prescriptions are processed and billed following internal policy third-party payer-provider agreements.
• Process rebill requests sent by various programs.
• Work with Pharmacy Supervisors to ensure that McKesson is following all Private and Public insurance policies.
• The National Billing Specialist reports to the National Billing Supervisor and performs national billing functions in a pharmacy setting. As a result, the roles are subject to all confidentiality and privacy requirements that apply in a pharmacy setting.
• Process various claims including manual submissions to various insurance providers.
• Actioning the shared inbox and completing tasks daily
• Work with the National Billing Supervisor to develop and implement IDP every year.
• Other duties as required.

Requirements

• Applicants must have at least a Grade 12 high school diploma or equivalent
• Minimum 3+ years of pharmacy Kroll billing experience with a high degree of accuracy
• Understanding of provincial public and private reimbursement for all province
• Strong communication and teamwork skills
• Possess finesse to manage relationships internally and externally.
• Accountable and results-oriented
• Self-motivated and able to work independently as well as in a team setting.
• Ability to communicate effectively (both oral and written) with internal and external customers and stakeholders; makes good decisions based on a combination of analysis, wisdom, experience, and judgment.
• Excellent interpersonal skills, ability to build and maintain good relationships with colleagues at all levels of the organization and promote harmony amongst team members, other McKesson employees / divisions, and external stakeholders.
• Consistently acts in a professional manner and serves as a role model for other team members
• Creative problem-solving skills to find solutions.
• Ability to reflect critically and receive feedback on leadership behaviour and modify when required.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please