Billing Pharmacy Technician: Claims & Resident Advocate

Mmprx; Illinois; Hybrid; USD 38,000 - 55,000; Full time

Job summary

Mmprx is seeking a Billing Pharmacy Technician to handle accurate profile entry, claim processing, and follow-up on resident prescription billing in Northern Kentucky. You will communicate with community staff, residents, and POAs, while staying current on Medicare Part D, Medicaid, and commercial insurances.

The role emphasizes investigation, accuracy, and timely service, with responsibilities covering claims adjudication, prior authorizations, and monthly statement processing.

Qualifications

• Minimum of one year pharmacy billing experience.
• 2+ years pharmacy technician experience.
• Licensed, and in good standing, Pharmacy Technician.
• National Pharmacy Technician Certification (PTCB or NHA).
• FrameworkLTC / FrameworkECM knowledge a plus.
• Basic algebra and pharmaceutical math knowledge.
• Excellent verbal and written communication skills.
• Professional demeanor with customer service.
• Highly organized and detail-oriented.
• Able to multi-task and meet deadlines.

Responsibilities

• Billing, processing, and follow-up related to resident prescription billing.
• Communicating with community staff, residents, and POAs as needed.
• Researching and staying up to date on different insurance providers.
• Generate monthly statements, process payments, and reconcile third-party claims.
• Adjudicating insurance claims and troubleshooting rejected claims.
• Completing and/or following up on prior authorization forms.
• Data entry into FrameworkLTC and FrameworkECM systems.
• Providing customer service through phones and emails.
• Analyzing pre- and post-adjudication reports for training and compliance.
• Following core processes and maintaining accuracy.

Skills

Insurance billing

Medicare Part D knowledge

Medicaid knowledge

Commercial insurance knowledge

Data entry

Customer service

Attention to detail

Phone and email communication

Insurance provider research

Multi-tasking

Education

High Diploma or equivalent

National Certification (PTCB/NHA)

Pharmacy Technician License

Tools

FrameworkLTC / FrameworkECM

Job description

Description

Shift: 12:30p - 9p, M-F, Rotating Saturdays

The Billing Pharmacy Technician is responsible for correct profile entry, processing, and follow-up related to the billing of resident prescriptions. Communication with community staff, resident(s), and/or POAs is of utmost importance for this role, along with researching, investigating, and staying up to date on different insurance providers.

The Billing Technician is an advocate for the residents we serve and a revenue generating function of the company – both roles are equally important. This in most cases requires an investigation mindset to research, follow-up, and ensure completion of billing tasks. Attention to detail and an inquisitive spirit is essential to success in this position.

Requirements

• Understanding of Medicare Part D, Medicaid, and Commercial insurances
• Adjudicating insurance claims and troubleshooting rejected claims
• Completing and/or following-up on prior authorization forms
• Data entry into Framework LTC and Framework ECM systems
• Providing customer service through phones, checking emails and messages to pharmacy and responding promptly and professionally
• Generating monthly statements, processing and entering payments, and reconciling third-party claims
• Analyzing pre- and post- adjudication reports for training opportunities and compliance
• Following core processes
• Is prompt and able to perform the required duties of the position on a regular, predictable basis

Qualifications

• Minimum of one year pharmacy billing experience
• 2+ years pharmacy technician experience
• High Diploma or equivalent
• Licensed, and in good standing, Illinois Pharmacy Technician
• National Pharmacy Technician Certification (PTCB or NHA)
• FrameworkLTC / FrameworkECM knowledge a plus
• Must have basic knowledge of algebra and pharmaceutical math
• Timely and accurate data entry skills
• Excellent verbal and written communication skills, establishing rapport and working with others
• Professional demeanor and appearance with excellent customer service skills
• Highly organized and attentive to detail
• Able to multi-task and work under deadlines
• Motivated, punctual and reliable team member
• Dedicated to providing exemplary customer service