Pharmacy Billing & Claims Specialist

DaMar Staffing; Klamath Falls (OR); On-site; USD 42,000 - 62,000; Full time

Job summary

Klamath Tribes Health & Family Services seeks a Pharmacy Billing Specialist to support billing of prescriptions and pharmacy services. Under supervision of the Pharmacy Billing Manager, you will ensure accurate demographic and billing information and work to maximize reimbursement.

Responsibilities include reviewing claims, posting payments, and assisting with audits while maintaining patient confidentiality and complying with HIPAA and related standards.

Qualifications

• High school diploma or equivalent required.
• Certified Oregon Pharmacy Technician Licensure must be submitted.
• Pharmacy Technician Certification (CPhT) required.
• At least ten years as a Nationally Certified Pharmacy Technician.
• Must be free from Federal health care exclusion lists.
• Training in fraud, waste and abuse for Medicare/Medicaid benefits required annually.

Responsibilities

• Billing of prescriptions claims and pharmacy services.
• Audit and review claims to ensure accurate adjudication.
• Post payments timely and reconcile claims to reduce denials.
• Coordinate with Patient Benefits for alternate resources when needed.
• Prepare prior authorization requests and follow SOPs.
• Maintain confidentiality per HIPAA and privacy requirements.

Skills

Pharmacy billing knowledge

Medicare/Medicaid billing

HIPAA compliance

Customer communication

Microsoft Word/Excel/Outlook

Strong attention to detail

Data accuracy in claims

Problem solving under time pressure

Education

High School Diploma or Equivalent

Certified Oregon Pharmacy Technician Licensure

Pharmacy Technician Certification (CPhT)

10+ years as a Nationally Certified Pharmacy Technician

Tools

Pharmacy billing software

Pharmacy computer systems

Microsoft Office Suite

Job description

Klamath Tribes Health & Family Services seeks a Pharmacy Billing Specialist to support billing of prescriptions and pharmacy services. Under supervision of the Pharmacy Billing Manager, you will ensure accurate demographic and billing information and work to maximize reimbursement.

Responsibilities include reviewing claims, posting payments, and assisting with audits while maintaining patient confidentiality and complying with HIPAA and related standards.