Overview

Full-Time - RIDC PARK, Pittsburgh, PA

Monday-Friday with Rotating Weekends and Evenings

This Billing Associate works internally with the Billing and Accounting Team, Pharmacist and Order Entry Team, Production Team. The Billing Associate works externally with Customers, and Third Party Insurance Personnel.

Responsibilities

• Data entry and review of patient demographics into pharmacy software program.
• Correspond with facility and family representatives to gather demographic information for the purpose of validating appropriate charges to facility and/or private pay accounts.
• Perform daily tasks as assigned.
• Adhere to Grane Rx billing and denial management processes and procedures.
• Review and process Medicaid pending claims.
• Maintain Low Income Subsidy (LIS) reports.
• Perform daily census reconciliation procedures to ensure census data is correct in pharmacy software program.
• Perform mid-month and end of month census reconciliation procedures to ensure that census data is correct in pharmacy software program.
• Perform hospice reconciliation procedures to ensure hospice data is correct in pharmacy software program.
• Process rebills as necessary.
• Produce month end and interim reports.
• Review of facility pre-bills to ensure accuracy.
• Review of facility invoices and rebill claims as necessary.
• Assist with prior authorization and non-formulary worksheets and process.
• Perform collection calls as needed.
• Triage of documents coming in from customers into pharmacy software programs.
• Ability to handle outbound and inbound phone calls from customers.
• Assists Manager with the preparation for Third Party Payors (PDPs) audits.
• Duties as assigned.

Qualifications

• Bachelor degree is preferred; High School diploma required.
• 1-5 years of LTC billing experience and experience.

EOE

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