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Title

Pharmacy Billing Technician (DHPI03) 

About the Organization Thank you for your interest in exploring the professionally rewarding and personally fulfilling benefits with Tuba City Regional Health Care Corp. We look forward to continuing our discussion about the opportunity and purpose health professionals experience as valued members of TCRHCC team.

A TCRHCC career offers a chance to live and work within or near Native communities, providing clinicians/nurses/administrators with a unique opportunity to learn the heritage of the tribes we serve, discover traditions that have been carried down for generations and gain cultural insight into the beliefs and values of a deserving and appreciative patient population.
 
Description

POSITION SUMMARY
The primary purpose of this position is to process third party claims (billing and collection) on-line to pharmacy insurance carriers for the cost of pharmaceuticals furnished to patients who are covered by health insurance policies and have received treatment at the facility. Also, provides claim processing for non-beneficiaries who receive medical services at the facility.

ESSENTIAL FUNCTIONS:

  1. Receives the pharmacy prescription dispensing reports electronically via on-line billing system. Determines if the prescription written by the provider is billable as defined by insurance guidelines. Verifies prescription amount dispensed for reimbursement by Pharmacy.
  2. Requests and obtains prior authorization for various pharmaceutical products from insurance companies. Receives and completes authorization forms providing all data required, obtains signatures, and returns as needed for processing of collection.
  3. Resolves problems associated with on-line billing. Researches and follows-up on rejected claims on-line in order to ensure maximum reimbursement to the facility, includes telephone contacts and any steps necessary for satisfactory resolution of the claim.
  4. Ensures pharmaceuticals are billed according to Dispense-As-Written (DAW), Drug Utilization Review, Dosaging, and Payer Format (BIN #) guidelines. Manages and reconcile rejects through interpreting clinical messages, DUR specification codes, and appending/amending claims for payment.
  5. Comprehends terminology for pharmaceutical products and correlate medical and clinical procedures and services provided by the facility against terms of the policies.
  6. Prepares end of month and quarterly status reports that list amounts billed, collected and not collected.
  7. Works rotational shift; Sunday through Saturday.
  8. Performs other duties as assigned.

MENTAL AND PHYSICAL EFFORT
The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:
The work is primarily sedentary with the following physical requirements: ability to lift up to 25 pounds, walk for short periods of time and sit for long periods of time, ability to stoop and pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, calculator, printer, fax, etc.
Exercises initiative and judgment in deviating from existing department or corporation practices to resolve billing issues/concerns. Work is reviewed for conformance to policies, procedures, and practices relating to billing practices.

 
Position Requirements

NECESSARY QUALIFICATIONS

Education:

  • High School Diploma or GED

Experience:

  • Minimum of one year experience related to pharmaceutical terminology, billing or general pharmacy operations

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

  • Positive working relationships with others
  • Possession of high ethical standards and no history of complaints
  • Reliable and dependable; reports to work as scheduled without excessive absences.
  • Working effectively in team relationships
 
Close Date 12/4/2021  
Exempt/Non-Exempt Non-Exempt  
Full-Time/Part-Time Full-Time  
Location Tuba City Regional Health Care Corporation  
Navajo/Indian Preference Applicants who are enrolled members of the Navajo Nation and who meet the necessary qualifications for this position will be given preference in hiring and employment for this position.  
Open Date 7/30/2021  

This position is currently not accepting applications.

To search for an open position, please go to http://TubaCityRegionalHealth.appone.com



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