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Form of workJob Summary
Provides LTC pharmacy billing and analysis of financial operations and information to provide decision support to executive staff.
Job Responsibilities
- Serves as first point of contact for all program issues.
- Maintains fiduciary responsibility which encompasses LTC billing of applicable patient by working closely with the third party vendors.
- Answers patients' questions on patient responsible portions, co-pays, deductibles, write-off's, etc.
- Resolves patient complaints or explains why certain services are not covered.
- Reviews IT reports to initiate billing. Enters information necessary for insurance claims such as patient information, insurance identification, diagnosis and treatment codes, modifiers, and provider information.
- Submits insurance claims to individual Medicare Part D/KY Medicaid insurance companies electronically through EPIC system.
- Communicates with payors and other necessary contacts to resolve issue and re-submit claims as needed and/or prepares and submits secondary claims upon processing by primary insurer as needed.
- Serves as consultant to all levels of management to provide decision support for initiatives, policies, and procedures.
- Performs or coordinates required continuous monitoring and/or auditing practices. Ensures claim information is complete and accurate.
- Coordinates annual registration and annual compliance with third party agencies.
- Stays up to date with any changes to the program requirements.
- Impacts quality and timeliness of deliverables by performing statistical, cost, and financial analysis of data extracted from various internal sources
- Performs special projects and duties as assigned, including necessary research.
- Advocates for the patient/family and provides explanation of benefits (EOB) when requested.
Qualifications
- High school diploma, General Equivalency Diploma (GED) or higher required upon hire AND
- Bachelor's degree or higher in Accounting preferred OR
- Bachelor's degree or higher in Business Administration preferred OR
- Bachelor's degree or higher in Finance preferred OR
- Bachelor's degree or higher in related field preferred
- No experience required
- CPhT - Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National HealthCareer Association (NHA) required within 6 months of employment in this position
Skills and Attributes
- Requires critical thinking skills and decisive judgment.
- Works under general supervision.
- Must be able to work in a stressful environment and take appropriate action.
- Requires a strong understanding of the specialized concepts, practices, and procedures in the area of specialization.
Physical Demands
- Standing: Occasionally
- Walking: Occasionally
- Sitting: Frequently
- Lifting 0-25 lbs: Rarely
- Lifting 25-75 lbs: Never
- Lifting over 75 lbs: Never
- Carrying 0-25 lbs: Rarely
- Carrying 25-75 lbs: Never
- Carrying over 75 lbs: Never
- Pushing/Pulling 0-25 lbs: Rarely
- Pushing/Pulling 25-75 lbs: Never
- Pushing/Pulling over 75 lbs: Never
- Climbing: Rarely
- Bending/Stooping: Rarely
- Kneeling: Rarely
- Crouching/Crawling: Rarely
- Reaching: Occasionally
- Talking: Frequently
- Hearing: Occasionally
- Repetitive Foot/Leg Movements: Never
- Repetitive Hand/Arm Movements: Frequently
- Keyboard Data Entry: Frequently
- Running: Never
- Vision: Depth Perception: Frequently
- Vision: Distinguish Color: Frequently
- Vision: Seeing Far: Frequently
- Vision: Seeing Near: Frequently
Owensboro Health Core Commitments
INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.
RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.
TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.
INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.
SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.
EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.
