LONG TERM CARE PHARMACY BILLING AND COLLECTION FULL-TIME DAY SHIFT 22340 bei New Bridge Medical Center

Join Our Team at New Bridge Medical Center!**

We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading healthcare provider, we offer a supportive and inclusive work environment. If you’re passionate about making a difference and thrive in a collaborative setting, New Bridge Medical Center is looking for a Long-Term Care Pharmacy Billing/ Collection.

Job Duties

Performing liaison with admitting, finance, and social service personnel to obtain prescription drug plan (PDP) information for all newly-admitted residents

Where PDP information is not available at the time of admission, performing E1 queries and, if necessary, contacting residents or family members to obtain PDP information.

Investigating and resolving PDP enrollment issues; counseling residents and/or family members on Part-D benefits.

Maintaining PDP and resident insurance plan information in pharmacy information system; ensuring that method-of-payment information is correctly set in pharmacy information system.

Claims management/batch management: adjudicating claims contained in pharmacists’ batches periodically throughout the day; resolving claims-adjudication issues; reversing claims in cases of overbilling or inappropriate billing.

Tracking and retro billing drugs for cases where prompt adjudication of claims is not possible.
Performing liaison with PDPs where payments appear to be incorrect.
Provide liaison for PDPs, physicians, and pharmacists for drugs that require prior authorization, step therapy, or have quantity limits.
Managing Medicare Part-B drug claims.
Preparing formulary and PDP enrollment reports/recommendations with the goal of maximizing revenues.
Review and posting of all account receivable activity.
Customer Service: respect, flexibility, knowledge, confidence, professionalism, pleasant attitude, patience and helpfulness. All responses should be timely, professional, caring, and respectful in accordance with Customer Service Performance expectations
Maintains established departmental policies and procedures, objectives, quality assurance program, safety, environmental, and infection control standards. Assesses gaps in policies and procedures, and create necessary policies and procedures to fulfill these gaps.
Understands and adheres to the Medical Center’s Code of Conduct.
Familiar with the Medical Center’s Mission, Vision, and Values Statements.
Other Duties:
Performs other duties as assigned to support the overall objectives of the department and organization.

Position Qualifications:
Two to five years of medical or pharmaceutical billing.
Demonstrated familiarity with computerized billing.
Working knowledge of medical terminology preferred.
Familiarity with third party billing policies and procedures including Medicare/Medicaid.
Thorough knowledge of ICD-9 and CPT coding systems.
Knowledge of diagnosis and other codes used on insurance forms.
Computer literacy.
Familiarity with medications and pharmacy desirable.
Must possess excellent interpersonal and communicative abilities.
Speaks, reads, and writes English to the extent required by the position.

Education:
High school diploma or equivalent required.

Job Setting/Physical Demands:
Inpatient and outpatient pharmacy areas; contact regulatory agencies, insurers.
Mainly sedentary with occasional reaching, bending, stooping, stretching crouching.
Mobility required.

Salary commensurate with experience within posted range.

We provide a comprehensive benefits package, including a competitive medical, dental, and vision plans. We prioritize work-life balance with a generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.