Pharmacy Billing Associate

Grane Rx; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Grane Rx, located in Pittsburgh, PA, is seeking a Billing Associate to collaborate with Billing, Accounting, Pharmacist, and Order Entry teams. The role involves external communication with customers and third-party insurance personnel, data entry, and Medicaid claim processing. Hybrid work arrangement available.

The ideal candidate has 1-5 years in LTC pharmacy billing and a Certified Pharmacy Technician credential, with a HS diploma and a preferred bachelor's degree.

Qualifications

• Bachelor's degree preferred; High School diploma required.
• 1-5 years of LTC Pharmacy and billing experience preferred.
• Certified Pharmacy Technician certification.

Responsibilities

• Data entry and review of patient demographics.
• Correspond with facility and family representatives to gather demographic information for billing validation.
• Perform daily tasks as assigned by the Billing team.
• Adhere to Grane Rx billing and denial management processes and procedures.
• Review and process Medicaid pending claims.
• Perform census reconciliation procedures to ensure census data alignment with facility records.
• Process Third Party Claims and rebills as needed.
• Produce month-end and interim reports.

Skills

LTC Pharmacy Billing

Data entry

Customer communication

Education

Bachelor's degree preferred

High School diploma required

Certified Pharmacy Technician

Job description

Overview

Full-Time - RIDC Park

Pittsburgh, Pa

Monday-Friday - Mostly Daylight - Rotating evenings and weekends - Hybrid

Our Billing Associate work internally with the Billing and Accounting Team, Pharmacist and Order Entry, and Production Teams. The Billing Associate works externally with Customers, and Third Party Insurance Personnel.

Responsibilities

• Responsibilities Include, but not limited to:

  • Data entry and review of patient demographics
  • Correspond with facility and family representatives to gather demographic information for the purpose of validating appropriate charges to facility and/or private pay accounts.
  • Perform daily tasks as assigned.
  • Adhere to Grane Rx billing and denial management processes and procedures.
  • Review and process Medicaid pending claims.
  • Remove Perform daily census reconciliation procedures to ensure census data is in alignment with facility census information
  • Perform comprehensive census reconciliation procedures to ensure that census data is correct.
  • Perform hospice reconciliation procedures to ensure hospice data is accurate
  • Process Third Party Claims
  • Perform necessary rebills and credits as needed Produce month end and interim reports.
  • Review of facility pre-bills to ensure accuracy.
  • Review of facility invoices and rebill claims as necessary.
  • Assist with prior authorization and non-formulary worksheets and process.
  • Triage of documents to appropriate work queues.
  • Ability to handle outbound and inbound phone calls from customers.
  • Assists with the preparation of Third Party Payors (PDPs) audits.
  • Duties as assigned.

Qualifications

• Qualifications

  • Bachelor’s degree is preferred; High School diploma required.
  • 1-5 years of LTC Pharmacy and billing experience preferred
  • Certified Pharmacy Technician

  Over 30 years, Grane Rx has been an industry leader, revolutionizing long-term care pharmacy solutions and services. The company focuses on caring for thousands of assisted living and nursing home residents along with onsite clinical consulting and training. Long Term Care and PACE pharmacy solutions from Grane Rx are currently available in four states.

EOE