Rx Billing Specialist

HMR Veteran Services; Anderson (SC); On-site; USD 40,000 - 56,000; Full time

Benefits offered by this job

401(k) with Company Match

Medical, Dental, and Vision Insurance

Employee Assistance Program (EAP)

Paid Time Off (PTO)

Tuition Reimbursement Program

Company-Paid Life Insurance

Job summary

HMR Veterans Services is seeking a Pharmacy Billing Specialist to manage the day-to-day pharmacy billing operations for our veteran care facilities. You will handle charging, recordkeeping, and monthly billing while coordinating with facility staff and the Billing Manager to ensure accuracy and timeliness.

Responsibilities include data entry for billing, supporting prior authorizations, payer communications, and auditing to ensure compliance with applicable laws and regulations.

Qualifications

• Must have a high school diploma or equivalent; prior pharmaceutical experience preferred.
• ,

Responsibilities

• Administer and perform day-to-day pharmaceutical billing in accordance with federal, state, and local standards.

Skills

Pharmacy billing

Independent decision making

Customer service

Communication

Patience

Computer literacy

Pharmacy terminology

Education

High school diploma or equivalent

Tools

QS1 pharmacy processor

Job description

Make a Difference in the Lives of Our Nation's Heroes

At HMR Veterans Services, we are proud to honor our mission of "Serving Those Who Served." If you are a passionate and dedicated Pharmacy Billing Specialistlooking for meaningful work, we invite you to join our team and make a lasting impact on the lives of America's Veterans.

Why Join HMR Veterans Services?

We value our team members and offer a comprehensive benefits package that includes:

• 401(k) with Company Match
• Medical, Dental, and Vision Insurance
• Employee Assistance Program (EAP)
• Paid Time Off (PTO)
• Tuition Reimbursement Program
• Company-Paid Life Insurance*
• And Much More!

What You'll Do

As a Pharmacy Billing Specialist, youadminister and perform the day-to-day functions of the pharmaceutical billing in accordance with current federal, state, and local standards, guidelines, and regulations as directed by the HMRx Billing Manager and HMRx Director of Operations. Responsibilities include:

• Perform administrative requirements such as completing necessary forms and reports.
• Maintain a productive working relationship with facility personnel who assist in the completion of supportive documentation.
• Responsible for charging, recording, and billing on a monthly basis.
• Responsible for data entry of required billing information and the setup of files for each resident.
• Work to address prior authorization and/or formulary exception issues.
• Provides support for Pharmacy department with regard to pharmacy billing issues which involves all payer sources.
• Timely monitoring of pharmacy “electronic claims log scan” to assure accurate pharmacy billing.
• Monitoring of prior authorizations to ensure payment.
• Prepare and send statements
• Track and report reconciliation payments
• Responsible for pharmacy aging in QS1 (pharmacy processor program) which includes identifying and acting on any outstanding accounts.
• Work with HMRx Director of Operations and HMRx Billing Manager in pursuing pharmacy contracts and pharmacy provider agreements
• Work directly with HMRx Billing Manager Services and HMRx Operations Director to provide financial statements and required monthly financial data.
• Work with HMRx Director of Operations and HMRx Billing Manager to ensure that pharmacy auditing information is addressed in a timely and accurate fashion.
• Performs other related assignments as required.

Qualifications

• Must possess, as a minimum, a high school diploma or its equivalent; prior pharmaceutical experience preferred.
• One year of Pharmacy Technician experience required or equivalent QS1 pharmacy processor knowledge and billing experience.
• Must possess the ability to make independent decisions when circumstances warrant.
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
• Must be knowledgeable of computer systems, system applications, and other equipment relative to pharmaceutical services.
• Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.
• Must be trustworthy, holding residents medical and personal information in confidence at all times.
• Must possess a thorough knowledge of the laws, regulations, and guidelines concerning pharmacy billing in the long-term care facilities.
• Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.
• Knowledge of general pharmacy terminology, brand and generic names of medications, and general medical terminology.
• Detailed knowledge of pharmacy insurance procedures.
• Must be able to cope with the mental and emotional stress of the position.

Join a Mission That Matters

When you join HMR Veterans Services, you're not just starting a job, you're becoming part of a team dedicated to serving those who have served our country.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.