Director of Purchasing and Inventory

Description

Must be available to work on site in Louisville or Lexington, KY

Job Summary:

The Billing Collections Specialist in a pharmacy plays a crucial role in ensuring the accurate and timely collection of payments from insurance companies, patients, and other third-party payers. This position requires strong attention to detail, excellent communication skills, and a solid understanding of insurance billing processes and regulations. The primary responsibility of a Billing Collections Specialist is to maximize revenue by minimizing outstanding balances and resolving billing discrepancies.

Duties and Responsibilities:

1. Billing and Claims Processing:

- Generate and submit accurate insurance claims to various payers, including private insurance companies, Medicare, and Medicaid.

- Verify patient insurance coverage, benefits, and eligibility.

- Review claims for accuracy, completeness, and compliance with insurance requirements and pharmacy policies.

- Resolve claim rejections, denials, and other billing errors.

- Follow up with insurance companies to ensure prompt payment of outstanding claims.

2. Collections and Payment Posting:

- Monitor and manage outstanding accounts receivable.

- Contact patients, insurance companies, and other third-party payers to collect overdue payments.

- Negotiate payment arrangements and develop repayment plans, when necessary.

- Post payments accurately to patient accounts and reconcile discrepancies.

- Investigate and resolve billing discrepancies and disputes.

3. Customer Service:

- Provide excellent customer service to patients, healthcare providers, and insurance representatives.

- Respond to inquiries regarding billing and insurance claims status.

- Address patient concerns and assist in resolving billing-related issues.

4. Compliance and Documentation:

- Maintain patient confidentiality and adhere to HIPAA regulations.

- Ensure compliance with federal and state laws and regulations related to billing and collections.

- Document all communication and activities related to billing and collections accurately and thoroughly.

5. Financial Reporting:

- Prepare and analyze reports related to accounts receivable, collections, and aging of outstanding balances.

- Identify trends and areas for improvement in billing and collections processes.

- Provide regular updates and reports to the pharmacy management team.

Requirements

Qualifications and Skills:

- High school diploma or equivalent (some employers may require an associate's or bachelor's degree).

- Previous experience in medical or pharmacy billing, collections, or healthcare finance preferred.

- Knowledge of insurance billing processes, reimbursement policies, and medical coding systems (e.g., CPT, ICD-10).

- Familiarity with pharmacy claims processing software and electronic health records (EHR) systems.

- Strong understanding of insurance regulations, including Medicare and Medicaid guidelines.

- Excellent communication and interpersonal skills for effective interaction with patients, healthcare providers, and insurance representatives.

- Attention to detail and accuracy in data entry, record-keeping, and financial reporting.

- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

- Proficiency in using office software (e.g., Microsoft Excel, Word) and billing software applications.

Note: This job description is a general overview of the typical duties and responsibilities of a Billing Collections Specialist in a pharmacy setting. The specific job requirements and responsibilities may vary depending on the organization, size of the pharmacy, and regional regulations.