You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Pharmacy Billing Specialist responsible for managing pharmacy billing and claims, handling inbound coordination for facilities, and ensuring accurate monthly processing. This role is crucial in maintaining data integrity and facilitating efficient billing operations in a growing LTC pharmacy organization.

Key Responsibilities

• Billing & Claims Management: Process pharmacy rejections, manage Prior Authorizations (PAs), and ensure all scripts are accurately billed to insurance.
• Census & Reporting: Perform census audits and run reports to verify that patient data in the system matches facility records before invoices are finalized.
• Inbound Coordination: Act as the primary contact for facilities and customers, handling approximately 10+ calls per day regarding billing questions or discrepancies.
• System Navigation: Utilize EMAR, SharePoint, and pharmacy-specific software daily to maintain data integrity and document workflow.
• Month-End Processing: Complete designated billing reports to ensure accurate monthly closing for over 20 Skilled Nursing Facilities (SNFs).

Qualifications

• Previous experience as a pharmacy tech is required.
• Proficiency in processing pharmacy rejections, working Prior Authorizations (PAs), and navigating insurance claims.
• High competency in computer systems, specifically EMAR and SharePoint; Excel skills are a strong plus.
• Experience with census-based billing, ensuring data accuracy between facility records and pharmacy invoices.
• Ability to handle inbound inquiries regarding billing discrepancies.

Skills

• Technical skills: EMAR and SharePoint proficiency.
• Soft skills: Professional communication and financial accuracy.

Additional Requirements

Reliable, predictable schedule with availability needed on the 1st of each month for month-end reports. If the 1st falls on a weekend, the team must be available that day, with a day off during the week.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Allied division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: providing direct patient care, accessing medical and confidential records, accessing and administering prescription medication or other drugs, working within a clinical setting, handling sharp instruments, conducting medical procedures, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.