Maniilaq Association

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Title:  Pharmacy Billing Specialist                                                                                                   Range: TBD  

Program:  Pharmacy                                                                                                                           Status:  Non-Exempt

Housing Priority:  None                                                                                                                     Covered:  Yes

POSITION SUMMARY

The Pharmacy Billing Specialist ensures the accurate and timely processing of all pharmacy billing and reimbursement activities for Maniilaq Health Center Pharmacy. This position reviews claims for accuracy, resolves denials, and assists patients with billing or insurance inquiries. The role collaborates closely with pharmacists, the Business Office, Patient Financial Services, and third-party payors to ensure compliance with federal, state, and payor regulations. The Pharmacy Biller supports the department’s financial performance through effective claim management, documentation, and communication.

PRINCIPLE DUTIES AND RESPONSIBILITIES

1. Maintains current working knowledge and usage of Cerner and ScriptPro TPMS.
2. Processes and submits monthly patient account statements to patients and Patient Financial Services.
3. Maintains all record-keeping documents appropriately for Federal, State and HIPAA rules and regulations.
4. Checks claims for errors, corrects errors, and resubmits corrected claims.
5. Handles patient and insurance telephone and written inquiries. Educates staff and patients as needed.
6. Initiates and follows up on all prior authorizations needed for successful pharmacy medication claim submission. Appropriately recognizes, maintains, and demonstrates discretion in handling and maintaining HIPAA Compliance guidelines and regulations.

7. Maintains current knowledge of Medicare, Medicaid, Workman’s Comp, VA, and private insurance rules and regulations regarding claims.  This includes, but is not limited to, bundling, covered services, responsible parties, Medicare/Secondary Insurance payor guidelines, patient liability and IHS and Maniilaq Health Center policies regarding beneficiaries and non-beneficiaries.
8. Handles patient and insurance telephone and written inquiries. Provides information and education to patients regarding their insurance payment, bills, and coverage as it applies to their account and individual financial responsibilities.
9. Contacts third party or other responsible payors via email, telephone or fax to follow-up on all outstanding accounts +30, +60, +90, and 120+ days, etc. on a daily basis.
10. Performs other duties as assigned by the supervisor to ensure that assigned work is completed in a timely manner.
11. Reports directly to the Chief Pharmacist and/or Deputy Chief Pharmacist for any clinical aspect of billing and to the Business Office Director for revenue collection matters.
12. Collaborates with Pharmacy, Alternate Resources, and IT teams to optimize electronic claim submission processes, troubleshoot transmission errors, and patients who need to be enrolled with third party payors.
13. Tracks and analyzes billing trends, reimbursement patterns, and denial rates; provides reports at frequency requested by department leadership, and recommendations to the Chief Pharmacist and/or Deputy Chief Pharmacist for process improvement.
14. Trains new and existing pharmacy staff on claim processing procedures, payor requirements, and HIPAA-compliant billing communication practices.
15. Monitors formulary and coverage changes for key payors and communicates updates to the pharmacy team to reduce claim rejections and patient delays.

MINIMUM REQUIREMENTS

High School Diploma or equivalent.  Licensed Pharmacy Technician in a U.S. state or territory.  Pharmacy Technician Certification (CPhT by the PTCB) encouraged but not required.  Working knowledge of medical terminology. Must be able to type at a sufficient rate to complete assigned duties.  Must be able to sort alphabetically and numerically.  Must have the ability to prioritize and carry out duties in a timely and accurate manner with minimal supervision.  Must be a team player. Must be able to travel to Kotzebue, Alaska, as needed.  Must possess good communication skills and be able to deal effectively with the public on sensitive issues, either in person or on the telephone.  Must be able to use computers with knowledge of Microsoft Word and Microsoft Excel for creating and editing reports and documentation.  Ability to learn the Cerner system for patient verification, the third-party billing package, and the accounts receivable system.  Must understand and adhere to strict confidentiality laws and policies for managing patient information.  Provide excellent internal and external customer service.  Must be available to work during the MHC outpatient pharmacy department hours of operation, in Alaska Daylight Time zone.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job.  They are not intended to be considered an exhaustive list of all responsibilities, duties and skills required of personnel in this job, and the employer reserves the right to revise or change this description.  This description does not constitute a written or implied contract of employment.  To perform this job successfully, an individual must be able to satisfactorily perform each of the above essential duties and meet physical demands.  Reasonable accommodations may be made to enable individuals with disabilities to meet those conditions.