Pharmacy Billing & Reimbursement Specialist

Overview:

Sunflower State/Show Me State Vital Care is seeking a detail-oriented Pharmacy Billing & Reimbursement Specialist to join our team. The ideal candidate will have a strong background in both pharmacy and medical billing procedures, as well as revenue cycle workflow. If you are looking to advance your career in healthcare revenue cycle management, we invite you to apply!

Key Responsibilities:

• Review and analyze pharmacy claims billed to both major medical and PBM payors for accuracy.
• Collaborate with corporate partners to verify patient information and insurance coverage for further billing accuracy.
• Work closely with insurance providers to manage follow-up on outstanding accounts by performing in-depth analysis to determine causes of unpaid/underpaid claims. Collect and provide actionable feedback to corporate partners to drive timely and accurate resolution.
• Utilize medical terminology to accurately document patient encounters.
• Maintain up-to-date knowledge of insurance regulations and reimbursement practices as it relates to; timely claims processing and submission, denial management to improve reimbursement, patient billing and collections of 3rd party payors, adjustments review, assist in payment reconciliation for timely posting of funds and review profitability data to identify low/negative margin therapies.

Required Qualifications:

• Previous experience in pharmacy billing, medical billing, coding, or revenue cycle management.
• Proficiency in ICD-10 coding systems.
• Previous experience in medical collection.
• Strong understanding of medical terminology and coding practices.
• Ability to work efficiently within electronic health record systems.
• Excellent communication and interpersonal skills.
• High school diploma or equivalent; Bachelor's Degree preferred.

Preferred Qualifications:

• Previous pharmacy technician experience (preferable in specialty or infusion pharmacy) or medical coding and/or billing experience.
• ASHP Pharmacy Revenue Cycle Management Certificate.
• Successful completion of a formal Pharmacy Technician training program.
• Current CPhT certification from PTCB or similar certification agency.
• Knowledge of healthcare reimbursement methodology.

Job Type/Location: Full-Time in Overland Park, KS or completely remote.

Schedule: Monday to Friday, 8am-5pm.

Pay Range: $20-$25/hour, based on experience

Job Type: Full-time

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Vision insurance

Education:

• High school or equivalent (Preferred)

Experience:

• RCM/Medical Billing: 2 years (Required)

Work Location: In person