Billing Pharmacy Specialist presso Oklahoma City Indian Clinic

Description

Oklahoma City Indian Clinic (OKCIC) is a non profit corporation that provides culturally sensitive health care to the American Indian population. OKCIC services not only include basic medical care, but also dental, optometry, behavioral health services, fitness, nutrition and other family programs.

Our mission is to provide excellent healthcare to American Indians. We do this by putting people first, providing quality services, and maintaining our Integrity and Professionalism.

We are looking to add compassionate team players to our growing team as we continue to work toward our goal of becoming the national model for American Indian Health Care.

The Oklahoma City Indian Clinic is seeking a Billing Pharmacist Specialist to join our growing Pharmacy Department. This position plays a vital role in ensuring accurate pharmacy billing operations and compliance with state, federal, and CMS regulations. The ideal candidate will combine strong clinical pharmacy knowledge with expertise in third-party billing, reimbursement models, and pharmacy revenue cycle management.

Job duties include, but are not limited to:

• Review pharmacy protocols, orders, and policies as requested.
• Analyzes and maintains the electronic portion of pharmacy billing operations for 3rd party programs and acts.
• Verbally communicates with claims processing personnel and facility staff to identify problems with applications and operating systems.
• Searches and retrieves individual patient health care records to gather and compile information for outpatient services.
• Maintains Medicaid, Medicare, and private/commercial insurance manuals and directives and also maintains reimbursement manuals in accordance with CMS and Oklahoma State Board of Pharmacy guidelines and regulations
• Trains pharmacy personnel on monitoring POS and changes related to billing the pharmacy package and POS.
• Provide monthly financial reports on revenue, collections, activities, and other reports as requested to the Pharmacy Director.
• Verify eligibility to third party payers.
• Provide support for internal pharmacy audits, billing, and financial analysis.
• Assist with pharmacy claims and adjudications.
• Works with all providers in completing documentation necessary for medication prior authorizations.
• Works with the Pharmacy Director to resolve any potential problems regarding reimbursement issues or potential areas to maximize reimbursement.
• Monitors high cost medications to verify patients are being given medications according to P&T guidelines and that all steps are in place to maximize the medication reimbursement.
• Ensures that prescription claims and reversals are in compliance with state and federal pharmacy laws and regulations.
• Ensure pharmacy contracts are compliant with state and federal regulatory guidelines, Centers for Medicaid/Medicare Services, and nationally recognized standards of pharmacy practice.
• Participate in quality improvement projects related to drug cost recovery and billing processes.
• Works diligently with all current and potential PBM’s to enhance the pharmacy third party contracts. Keeps up to date records of existing contracts and sends contracts for review prior to executing a contract.
   

The Oklahoma City Indian Clinic is a non-profit organization and not federal employment. Indian preference hiring laws apply. The Clinic is a 501(c)(3) non-profit corporation and an Equal Employment Opportunity (EEO) employer. The Clinic adheres to all applicable laws prohibiting discrimination in employment, including protections based on race, color, sex, national origin, age, disability, religion, veteran status, and other characteristics as required by federal, state, or local law.

For Indian Preference to apply, you must complete the full application and submit a copy of your CDIB card.

Qualifications

• Must align with OKCIC vision, mission, and core values.
• Due to the safety-sensitive nature of this position, medical marijuana license holders who test positive for marijuana will not be qualified for this position.
• Bachelor’s or Doctorate degree in pharmacy recognized by the American Council on Pharmaceutical Education
• 2 years of experience in a retail pharmacy or other outpatient setting with pharmacy point of sale billing
• Knowledge about pharmacy revenue cycle, reimbursement models, and denial management activities.
• Licensed and in good standing with the Oklahoma State Board of Pharmacy
• Current preceptor license
• Current immunization license.