The Pharmacy and DME Billing Professional plays a crucial role in managing the Revenue Cycle process for a community health center's owned pharmacies. This position ensures adherence to policies and procedures while maintaining high standards of productivity and accuracy. Responsibilities include timely claim processing, effective communication with pharmacy staff, providers, insurance payers, and patients, and upholding data integrity and confidentiality. The role actively supports the organization's mission and fosters a positive work environment.
Duties And Responsibilities
Develop and maintain DME billing protocols and ensure accreditation compliance.
Collaborate with the Director of Pharmacy and CFO to update pharmacy and DME billing policies and procedures.
Submit clean claims electronically or via paper to third-party payers.
Identify and resolve claim and payment-related issues, including denials and insurance follow-ups.
Maintain strict confidentiality and adhere to HIPAA guidelines.
Assist patients with billing inquiries and concerns.
Reconcile pharmacy third-party payments using management software.
Communicate Revenue Cycle issues promptly to supervisors.
Stay updated on current coding requirements.
Prepare patient statements and manage patient collections.
Handle patient billing and invoicing.
Address client billing discrepancies and resolve issues promptly.
Support community programs providing financial assistance for prescriptions.
Generate financial statements and process payments accurately.
Provide guidance to pharmacy staff to ensure billing accuracy.
Assist in 340B savings management and analysis.
Work towards achieving monthly S.M.A.R.T goals.
Meet productivity standards effectively.
Perform other duties as assigned.
Qualifications
Preferred experience in pharmacy and DME billing.
Certification as a coder (CCS-P or CPC) is advantageous.
Proficient in billing procedures with strong attention to detail.
Able to work independently with moderate supervision.
Effective problem-solving skills with a sense of urgency.
Interest in collaborating with diverse patient populations.
Committed to upholding organizational values of Compassion, Respect, Collaboration, and Integrity.
Demonstrates a high level of confidentiality.
Working Conditions
Full-time, non-exempt position averaging 40 hours per week.
Work hours may vary Monday to Friday between 8:00 AM and 5:00 PM, as required.
Schedule flexibility based on operational needs.
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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