Pharmacy Billing Supervisor

Westminster Brand 051816; Orlando (FL); On-site; USD 60,000 - 85,000; Full time

Job summary

Longevity Scripts in Orlando, FL seeks a Pharmacy Billing Supervisor to lead the billing office in admissions, billing, and adjudication of pharmacy services, and to oversee reconciliation of accounts receivable.

You will direct billing staff handling third-party claims, Medicare Part D, Medicaid, and managed care, resolve denials and prior authorizations, and ensure timely cash collections and monthly revenue reporting.

Qualifications

• 3–5 years LTC business office experience required.
• Knowledge of Medicare Part D, Medicaid, managed care, and third-party adjudication processes.
• Experience resolving insurance claim rejections, denials, and prior authorization issues preferred.
• Knowledge of long-term care pharmacy operations and nursing facility workflows preferred.
• Experience with pharmacy management and billing software (Frameworks LTC).
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Strong organizational skills with multiple priorities in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong problem-solving and critical-thinking abilities.
• Ability to maintain confidentiality and HIPAA requirements.

Responsibilities

• Directs billing office staff in processing pharmacy services claims per policies and laws.
• Oversees reconciliation of third-party claims and accounts receivable.
• Collaborates with Pharmacy Controller to maximize gross margins and provide revenue data.
• Ensures timely cash collections and month-end revenue reporting.
• Interacts with facilities, physicians, and pharmacy teams to promote teamwork.
• Handles remittance processing via NetRx, Sage 300, and MHA software.
• Assists in hiring and training of billing staff.
• Maintains confidentiality of patient and employee information.

Skills

LTC billing

Medicare Part D

Medicaid

Third-party claims

Insurance denial resolution

Pharmacy billing software

MS Office

Organization

Communication

HIPAA compliance

Problem solving

Tools

Frameworks LTC

NetRx

Sage 300

MHA

Job description

Longevity Scripts is seeking to fill a Pharmacy Billing Supervisor position at our pharmacy located in Orlando, FL. This position is responsible for supervising billing office staff in daily operations of admissions, billing, and adjudication of pharmacy services. This role will also oversee reconciliation of account receivables and develops methodology for prompt payment. EOE/DFWP - We honor those who serve.

Scope of Responsibilities/Accountability:

• Directs billing office staff in processing pharmacy services claims in accordance with internal policies and procedures, federal and state laws, as well as appliable professional standards to ensure that billing functions are performed accurately, timely, and in compliance with pharmacy service contracts.
• Maintains confidentiality of all patient and/or employee information to ensure patient and/or employee rights are protected.
• Manages submittal of claims with third party insurance, private pay residents, workers compensation, facility Medicare Part A and Managed Care charges including outlier charges, and house stock charges.
• Provides leadership and guidance to billing staff regarding positively handling billing inquiries from sponsors or other responsible parties.
• Ensures reconciliation of third-party claims
• Works with Pharmacy Controller to provide statistical revenue information and to develop strategies for maximizing gross margins.
• Oversees and coordinates billing office team members in daily billing, credits, and remittances from third party plans.
• Maintain gaining reports and timely cash collections
• Performs all month end processes to ensure all monthly revenues are recorded and reported accurately and in a timely manner.
• Works closely with Westminster Communities to provide all documentation necessary for accurate production of monthly pharmacy invoicing
• Responsible for daily remittance processing through designated software systems (i.e., NetRx, Sage 300, MHA, Inc.)
• Manage and maintain accurate electronic records for all pharmacy receivables.
• Responsible for resolution of rejections, denials, and prior authorizations associated with third party insurance claims (i.e., PDPs, Medicaid, etc.)
• Educates staff on proper processes and procedures to coordinate workflow
• Participates in the hiring process and coordinates the orientation and training of the billing staff
• Frequent interaction with facilities, physicians, and other pharmacy team members at all levels; promoting teamwork and demonstrates strong leadership skills and professionalism
• Verifies and clarifies any and all problems or inquiries with the facilities documentation requests/needs
• Utilize reference materials available to improve skills regularly including training and continuing education
• Promotes customer services and enhances brand image to support the overall organizational mission
• Various pharmacy office duties as determined by the Pharmacy Controller
• In the absence of the Pharmacy Controller, is able to stand in as interim Controller.

Essential Qualifications:

• 3-5 years LTC Business office experience required
• Working knowledge of Medicare Part D, Medicaid, managed care plans, commercial insurance, and third-party claim adjudication processes.
• Experience resolving insurance claim rejections, denials, and prior authorization issues preferred.
• Knowledge of long-term care pharmacy operations and nursing facility workflows preferred.
• Experience with pharmacy management and billing software systems preferred (i.e., Frameworks LTC).
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong problem-solving and critical-thinking abilities.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Applicants can learn more about Florida background screening requirements at https://info.flclearinghouse.com/.