Pharmacy Billing Specialist

WVE WVNH EMP LLC; West Virginia; Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Job summary

CommuniCare Family of Companies is seeking a Pharmacy Billing Specialist to manage and update patient accounts, ensuring billing processes align with the billing manual throughout our hybrid/remote pharmacy network across WV, OH, IN, and MD.

You will verify insurance, work with Medicare Part D and managed care plans, and collaborate with facility managers to resolve census clarifications while maintaining compliance with HIPAA and all applicable regulations.

Qualifications

• Experience with pharmacy billing processes.
• Familiarity with Medicare Part D, Medicaid and managed care.
• Adherence to HIPAA regulations.

Responsibilities

• Follow billing processes per the billing manual to ensure consistency.
• Verify and update patient insurance information (Medicare Part D, Commercial, Medicaid).
• Collaborate with facility business office managers for Medicare Part D plans and Census clarifications.
• Daily reviews of SQL reports to ensure clean facility invoices.
• Adhere to federal and state regulations and company policies.

Skills

Billing software

Medicare Part D

HIPAA compliance

Long-Term Care billing

Tools

Framework LTC

Job description

Job Address:

15063 MacCorkle Avenue Cabin Creek, WV 25035

Job Description:

Pharmacy Billing Specialist

Reports to:

Pharmacy Billing Supervisor

Job Type:

Full-Time – Hybrid/Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland

Position Overview:

Manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the billing manual.

Key Responsibilities:

Follow all billing processes as outline in the billing manual to ensure consistency and prescription integrity for compliance. Maintain all current patient accounts by verifying, adding or editing current insurance (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care). Works closely with the facility business office managers for Medicare Part D insurance plans and Census clarifications. Works directly with several hospice plans and third party plans as needed. Daily reviews of SQL reports setup to ensure a clean facility invoice. Any other assigned duties that relates to billing. Follow federal and state regulations. Adhere to company policies and procedures. Follow HIPPA guidelines and regulations.

Qualifications:

• Previous Long-Term Care pharmacy experience a plus (but not required)
• Knowledge of Framework LTC a plus (but not required)

Salary and Benefits:

Competitive salary commensurate with experience

Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more

Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.