Pharmacy Billing Specialist: Claims, Audits & Authorizations

Klamath Tribal Health & Family Services; Klamath Falls (OR); On-site; USD 40,000 - 71,000; Full time

Job summary

Klamath Tribal Health & Family Services seeks a Pharmacy Billing Specialist to support billing for prescriptions and services under Pharmacy Billing Manager supervision. The role emphasizes accurate claims processing and adherence to tribal and federal regulations.

Responsibilities include auditing claims, coordinating with Pharmacy staff, and assisting in prior authorization and patient resources. Requires strong computer skills and experience with Medicare/Medicaid billing in a health system

Qualifications

• High school diploma or equivalent.
• Oregon Pharmacy Technician Licensure required.
• Pharmacy Technician Certification (CPhT) required.
• Ten years of experience as a nationally certified Pharmacy Technician.
• Must be free from Medicare/Medicaid exclusion.
• Annual training in fraud, waste and abuse detection for Medicare/Medicaid.
• Proficient with Excel, Word and Outlook.

Responsibilities

• Review, audit and bill pharmacy claims for prescriptions and services.
• Collaborate with Pharmacy staff to answer billing questions.
• Post refunds and reconcile payments per protocol.
• Identify opportunities to improve patient eligibility for alternate resources.
• Support prior authorization requests and ensure timely processing.

Skills

Billing and claims knowledge

Communication skills

HIPAA/privacy compliance

Microsoft Office (Word, Excel, Outlook

Education

High School Diploma or Equivalent

Oregon Pharmacy Technician Licensure

Pharmacy Technician Certification (CPhT)

Tools

Pharmacy computer systems

Excel/Word/Outlook

Job description

Klamath Tribal Health & Family Services seeks a Pharmacy Billing Specialist to support billing for prescriptions and services under Pharmacy Billing Manager supervision. The role emphasizes accurate claims processing and adherence to tribal and federal regulations.

Responsibilities include auditing claims, coordinating with Pharmacy staff, and assisting in prior authorization and patient resources. Requires strong computer skills and experience with Medicare/Medicaid billing in a health system