Pharmacy Claims Specialist

Tuba City Regional Health Care Corporation (TCRHCC); Tuba City (AZ); On-site; USD 32,000 - 48,000; Full time

Job summary

Tuba City Regional Health Care Corporation (TCRHCC) seeks a Pharmacy Billing Clerk to process third-party claims and handle billing for pharmaceuticals provided to patients with health insurance. The role supports both beneficiaries and non-beneficiaries in accordance with policy and plan rules.

The successful candidate will have at least a high school diploma and one year of related experience, with strong attention to detail, reliability, and ethical standards.

Qualifications

• High School Diploma or GED is required.
• Minimum of one year of experience related to pharmaceutical terminology, billing, or general pharmacy operations.
• Evidence of positive employment references addressing teamwork, ethics, reliability and performance.

Responsibilities

• Collect self-pay amounts at point of sale or via reporting.
• Coordinate with Patient Registration, Pharmacies, and Benefit Coordinators.
• Process pharmacy claims and verify billable amounts for reimbursement.
• Resolve rejected claims by checking insurance guidelines and data.
• Prepare end-of-month and quarterly reports listing billed, collected, and uncollected amounts.
• Work rotating shifts, including weekends, as scheduled.
• Follow proper PPE and safety procedures at all times.

Skills

Pharmaceutical terminology

Billing

Pharmacy operations

Education

High School Diploma or GED

Tools

Online billing system

Job description

Tuba City Regional Health Care Corporation (TCRHCC) seeks a Pharmacy Billing Clerk to process third-party claims and handle billing for pharmaceuticals provided to patients with health insurance. The role supports both beneficiaries and non-beneficiaries in accordance with policy and plan rules.

The successful candidate will have at least a high school diploma and one year of related experience, with strong attention to detail, reliability, and ethical standards.