Pharmacy Billing Specialist

Locations: Klamath Falls, OR Type:Tribal Salary Range:Salary Negotiable Open Period:1/3/2024 until filled Summary:RESPONSIBLE TO: Pharmacy Billing Supervisor SALARY: Steps: 12-31 CLASSIFICATION: Non-Management, Full-time, Regular LOCATION: Klamath Tribal Health & Family Services Business Office 3949 South 6th Street, Klamath Falls, OR IT IS THE RESPONSIBILITY OF THE APPLICANT TO PROVIDE SUFFICIENT INFORMATION TO PROVE QUALIFICATIONS FOR TRIBAL POSITIONS. Please Note: If requirements are not met, i.e., submission of a resume in lieu of a tribal application or not including a required certification, your application will not be reviewed and will be disqualified. Indian Preference will apply. In accordance with Klamath Tribal policy, priority in selection will be given to qualified applicants who p re sent proof of eligibility f o r "Indian Preference". Applications will not be returned. More info about area: Job Announcement Flyer: Duties:1.Proactively gain knowledge to maintain a high level of industry knowledge related tothe review/ audit and billing of pharmacy claims for prescriptions and pharmacyservices. 2.Collaborate with and be available to pharmacy personnel for timely response andsupport for billing questions and needs. 3.Build and retain positive and professional relationships with external KTHFS businesspartners. 4.Use implemented and established processes to assure and maintain accurate demographic and billing information. 5. Use implemented high quality pre and post claims review of each prescription filled and pharmacy services to be billed. Ensure claims submission adheres to KTHFS values, mission and vision, ensuring claims are precisely and legally adjudicated and billed in effort to obtain maximum allowable reimbursement. 6. Proactively identify opportunities to improve alternative resources for patients. Effectively work with KTHFS Patient Benefits personnel to screen and refer for potential eligibility of alternate resources. 7. Responsible for the request and submission of pharmacy prescription prior authorization requests. 8. Accurately and efficiently post pharmacy payments in a timely manner per protocol when requested. 9. Use implemented process to ensure successful reconciliation of pharmacy claims working to provide 100% payment and receipt of all claims. 10. Proactively review claims history and rebill underpayments and non-payments, claims missed on insurance and/or errors found with the review/audit process. 11. Assist the Pharmacy Staff with pharmacy audits. 12. Communicate with tribal members, descendants, caregivers, and other health care professionals, regarding Prior Authorizations according to the Pharmacy Business Office SOP. Maintain training specific to Prior Authorizations and the detection, correction and prevention of fraud, waste and abuse in the delivery of Medicare and Medicaid benefits. 14. Maintain other standard annual required training for health care workers or any training required by KTHFS such as Blood Borne Pathogen, HIPAA Privacy and Security, and others as deemed necessary. 15. Attend and participate in regular Business Office and other meetings when requested by Pharmacy Billing Supervisor. (see attached pdf for full listing) Qualifications:KNOWLEDGE, SKILLS, ABILITIES Possess knowledge of Oregon and federal regulations regarding pharmacy operations, rules and regulations. Possess skilled knowledge of private insurance, Medicare and Medicaid billing of pharmacy services. Ability to perform work and accomplish tasks following specific Policy and Procedures set forth in the Pharmacy SOP and priorities of the pharmacy. Must be able to communicate effectively both orally and in writing with patients, caregivers, pharmacy personnel, and other health care professionals. (see attached pdf for full listing of Knowledge, Skills, and Abilities) Minimum Qualifications: Failure to comply with minimum position requirements may result in termination of employment. REQUIRED to possess a High School Diploma or Equivalent. (Must submit copy of diploma or transcripts with application.) REQUIRED to have at least three (3) years working as an experienced Nationally Certified Pharmacy Technician. REQUIRED to be free from exclusion from providing Federal health care benefits including Medicare and Medicaid as per the Federal OIG and GSA exclusion lists. REQUIRED to receive training specific to the detection, correction and prevention of fraud, waste and abuse in the delivery of Medicare and Medicaid benefits. Training shall be performed within 30 days of hire and at least annually thereafter REQUIRED to have excellent computer skills and word processor experience. REQUIRED to have knowledge of records management. REQUIRED to submit to annual TB skin testing and adhere to KTHFS staff immunization policy in accordance with the Centers for Disease Control immunization recommendations for healthcare workers. REQUIRED to submit to a background and character investigation, as per Tribal policy. Following hire must immediately report to Human Resource any citation, arrest, conviction for a misdemeanor or felony crime. Preferred Qualifications: Graduation and successful completion from an accredited Pharmacy Technician training school. Applicable specialized experience billing, auditing or managing pharmacy benefits. Certified Oregon Pharmacy Technician Licensure. (Must submit a copy of certification with application.) Pharmacy Technician Certification (CPhT). (Must submit a copy of certification with application.) Indian Preference: Indian and Tribal Preference will apply, as per policy. (Must submit tribal documentation with application to qualify for Indian Preference). Work Type:Permanent, Full Announcement :KTHFS-24-PBS