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PHARMACY BILLING REPRESENTATIVE

Company: UMASS Memorial Medical Center
Location: Worcester
Posted on: November 11, 2018

Job Description:

Requisition #: 183629

Title: Pharmacy Billing Rep

Department: Pharmacy

Grade: ADM5

Posting Date: July 17, 2018

Status: Non-Exempt

Shift: Days

Union: SHARE

Hours: 40

Shift Length: 8 hours

Location: UMass Memorial Medical Center - University Campus

Hours are Monday through Friday

UMass Memorial Medical Center is the region's trusted academic medical center, and part of the UMass Memorial Health Care system. We are committed to improving the health of people in Central Massachusetts through excellence in care, comprehensive health services, teaching and research.

Position Summary:

Responsible for interpreting all diagnostic and procedure codes related to medications for services performed in the hospital. Processes pharmacy charges using a computerized billing system. This position verifies insurance medication requirements, i.e. prior authorizations, medical necessity on each patient admission and inputs relevant information into computer based patient information/registration/ system.

Position Qualifications:

Minimum, High School Diploma required. Three years' billing experience in a medical setting or related insurance experience required. Knowledge of medical terminology and prior working knowledge of ICD-9 and CPT coding systems required. Knowledge of third party requirements as they relate to insurance verification / authorization. Computer skills to include mainframe and various PC applications including Word, Excel, Access and Power Point. Ability to problem-solve, and to organize and prioritize work to meet strict deadlines. Must maintain current knowledge of coding and billing practices through reading of newsletters, publications and attendance at seminars. . Demonstrated ability to work with computerized systems such as a PC, Point of Service device and online interfaced systems. Must possess communication skills sufficient to interact with multiple departments physicians, nurses, third party carriers and organizational ability to manage workload.

Major Responsibilities:

Researches all assigned incomplete charge documents, sorts charge documents by Pharmacist and time order and batches the charge documents under the supervising attending for that session.

Analyzes documentation and ensures appropriate ICD-9, CPT codes and modifiers for all charges which include all medication related charges. Enters pharmacy codes, dose, date and route directly into Meditech Pharmacy System. Enters appropriate ICD-9 codes for immunizations.

Researches and resolves coding issues to accurately reflect correct diagnosis, to expedite billing and to resolve incomplete and missing chart documentation. Maintains direct and ongoing communication with Central Billing for problem resolution as warranted.

Participates in improvement efforts and documentation training for Pharmacists and other department staff as it relates to coding practices and guidelines.

Communicates to supervisor when backlog situations arise or necessary documents are either incorrect or are not being received on a timely manner.

Informs management of any coding irregularities or trends contrary to policy or procedure and communicates with clinical staff if necessary and appropriate.

Investigates all outpatient/observation admissions or surgical day registrations for insurance eligibility and authorizations and any other vital information needed to collect payment.

Corresponds with third party carriers, physicians and/or patients to obtain insurance data necessary for payment.

Verifies and inputs data into the Meditech or other computer system.

Verifies insurance coverage using automated eligibility systems.

Maintains daily statistics on charges processed for Pharmacists.

Performs pharmacy billing when necessary.

Complies with established departmental policies, procedures, and objectives.

Attends variety of meetings, conferences, and seminars as required or directed.

Demonstrates use of quality improvement in daily operations.

Complies with all health and safety regulations and requirements.

Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

Keywords: UMASS Memorial Medical Center, Worcester , PHARMACY BILLING REPRESENTATIVE, Accounting, Auditing , Worcester, Massachusetts

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