Financial Coordinator - Pharmacy

LVHN; Allentown (Lehigh County); On-site; USD 42,000 - 64,000; Full time

Job summary

Lehigh Valley Health Network (LVHN) seeks a Pharmacy Billing professional to monitor financial information and authorizations to ensure appropriate patient coverage. You will communicate with carriers, obtain authorizations, and counsel patients on covered services and financial responsibility.

You will monitor payments, apply adjustments, verify insurance coverage, and serve as a billing resource for colleagues and patients, with knowledge of pharmacy operations including order preparation and

Qualifications

• High School Diploma or GED and experience in medical billing or pharmacy-related field.
• Knowledge of ICD-10, CPT, HCPCS coding and insurance requirements.
• Computer proficiency and familiarity with billing systems.

Responsibilities

• Act as the financial representative to pharmacy patients and verify insurance coverage.
• Educate patients on coverage, prescription benefits, and assistance programs.
• Obtain pre-certification and prior authorization as required by insurers.
• Verify billing and payment information and maintain accurate records.
• Coordinate with Pharmacy to support outpatient infusion services and payment processing.

Skills

Insurance verification

Medical billing

Pharmacy operations knowledge

ICD-10 CPT HCPCS knowledge

Computer proficiency

Education

High School Diploma/GED

Bachelor's Degree

CPhT Certification (PA) Upon Hire

Tools

Billing software

Pharmacy operations software

Job description

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Monitors and obtains financial information and authorizations to ensure appropriate coverage for patients related to Home Infusion Pharmacy, Nursing and Specialties. Communicates medical conditions and treatment plans to carriers and suppliers to determine coverage. Obtains authorizations for services if needed. Provides counseling to patients and their families regarding covered services and financial responsibility. Monitors, applies payments and adjustments on Accounts Receivable. Works closely with Pharmacy to coordinate outpatient infusion services. Knowledge of pharmacy operations is required.

Job Duties

• Acts as the financial representative to all potential pharmacy patients.
• Maintains a perpetual knowledge of pharmacy Payer standards and requirements for pharmacy patient billing.
• Educates patients on coverage, prescription coverage, and any assistance programs that they may be eligible.
• Obtains pre-certification and/or prior authorization if required by insurance companies and ensures that they are always up-to-date and active.
• Verifies accuracy of billing and payment information received and assists in obtaining more information.
• Verifies patient insurance coverage including prescription coverage.
• Maintains up-to-date documentation regarding insurance information and coverage.
• Serves as a billing and insurance resource for colleagues, physicians, and patients.

Minimum Qualifications

• High School Diploma/GED
• 3 years Insurance verification or medical billing. or
• 3 years in a Pharmacy related field
• Knowledge of medical terminology and all aspects of coding including ICD-10, CPT, and HCPCS.
• Computer proficiency.
• Knowledge of insurance carriers, Medicare, Medicaid, and managed care regulations.
• Knowledge of third-party insurance medical benefits and billing requirements.
• Knowledge of pharmacy operations including order preparation, patient monitoring and home delivery.

Preferred Qualifications

• Bachelor's Degree
• CPhT - Certified Pharmacy Technician - State of Pennsylvania Upon Hire

Physical Demands

• Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

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Work Shift: Day Shift

Address: 2024 Lehigh St

Primary Location: Allentown - 2024 Lehigh Street

Position Type: Onsite

Union: Not Applicable

Work Schedule: M-F 8a