Providence Pharmacy Billing Specialist in Portland, Oregon
Providence is calling a Pharmacy Billing Specialist - Home Services Specialty Pharmacy (1.0 FTE, Days) to HS Building in Portland, OR
We are seeking a Pharmacy Billing Specialist - Home Services Specialty Pharmacy that will be responsible to proactively audit, monitor, and analyze complex dispensing and charging information, processes and controls in order to ensure revenue integrity for Home Services (HS) and Credena Health (CH) lines of business. This includes Infusion, Long Term Care (LTC) and Credena Health pharmacies. This position responds to and resolve pharmacy billing issues and facilitates charge capture process improvements.
In this position you will have the following responsibilities:
Analyze/troubleshoot/resolve pharmacy charging and billing anomalies and includes appropriate part in decision-making (Pharmacy Operations Manager, Pharmacy Director, Direct Pharmacy Supervisor, Billing Office Manager, etc.)
Validate the medication delivery tickets (e.g. billing unit, charge algorithm, product) by working assigned work queues and or monitoring daily pharmacy charge reporting
Communicate with members, patients, payors, network pharmacies, providers, and other ancillary departments to obtain necessary information that is subject to both federal and state review and or audit
Evaluate charging/price structures to ensure consistent and accurate pharmacy charging methods across HS and CH pharmacy lines of business
Process appropriate pharmacy billing corrections as identified in the daily charge review process or as received from the Business Office
Maintain current knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPS) principles, HS & CH contract pricing, reimbursement policies including the medical coverage criteria and requirements of individual payers
Required qualifications for this position includes:
High School Diploma -OR- GED
Current Oregon Board of Pharmacy Technician registration
Three (3) years of experience in health care or pharmacy billing, collections or medical claims processing
Three (3) years experience with computers in data entry/inquiry
Preferred qualifications for this position includes:
Bachelor's Degree in Math, Business, Healthcare Administration or related field
Three (3) years of work experience in as a pharmacy technician in specialty setting (e.g. long term care, infusion or specialty pharmacy)
Experience with insurance/data inquiry systems
Experience using electronic medical records software
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Pharmacy Technician
Req ID: 268791
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