Billings Operations Manager - Pharmacy

Billings Operations Manager - Pharmacy

Billings Operations Manager - Pharmacy
Company:
Facility: Consonus Pharmacy-Oregon, Milwaukie, OR
Schedule: Full-Time
Shift: Days
Hours:
Job Details:
* Bachelors or Higher Degree
*
As thePharmacy Billing Operations Manager, you will oversee the total operations of the Billing Department, to include six different departments that make up the entire Pharmacy Billing process.

General responsibilities will include, but are not limited to:

· Oversees the accurate and timely billing of all goods and services.
· Manage all updates, changes and improvements necessary to ensure daily billing processes are running efficientlyusing IT systems and other resources.
· Responds or delegates billing inquires timely and professionally.
· Ensure all business review requests are handled timely.
· Respond to all Customer Action Requests timely.
· Prepares month end, quarterly and annual reports to General Managers and Controller.
· Support Pharmacy Consultants and Sales staff with customer requests as necessary.
· Perform other duties and responsibilities as assigned.

In addition, you will manage and schedule billing employees to ensure appropriate coverage in the following departments:

Intake Department
· Oversees accuracy of patient profiles (payer status, billing addresses, etc)
· Ensure daily admits are processed timely.
· Temp Bed report reviewed 3 times per week.
· Received Admit Pack Queue - cleared out daily.
· Sent Admit Pack tracking to ensure documents are resolved within 90 days.

Conversions Department
· New homes' billing information setup performed timely.

Third Party Department
· Communicates with federal agencies and private contractors for clarification of accounts/contracts.
· Oversees setup of Third Party plans and ensures setup is timely and accurate.
· Ensure daily rejects are resolved timely and accurately.
· Ensure cycle fill rejects are resolved timely and accurately.
· Ensure Stat/Sat rejects are resolved timely.
· Hospice documents to be reviewed and updated daily.
· Ekit/Pyxis rejects - must be completed by month-end.
· Combines - must be completely resolved by month-end.
· Delinquent A/R Queue - resolve the documents timely.

Medicare Part B Department
· Ensure daily Med B rejects are resolved timely.
· Ensure pending queue is being reviewed and updated weekly (Doctor letters, AOB, ABN, etc).
· Noridian payments/RA's processed daily.
· Co-payments checks are processed weekly.
· MTM billing stays current.
· Paper-billing for Pharmacy claims.
· Reversals/charges - AOAP completed at month-end.
· File determinations with Medicare timely.
· Work all denials/unbilled claims (online, paper claims, etc).

Medicare D Specialist
· Ensure specialist stays on task to manage our Part D plan preferred list.
· Manages goals and expectations of enrollment switches.

Billing Specialist
· Ensure specialist stays on task with special projects (NCPDP D.0, conversion, etc).

Qualified candidates will have the following experience:
*
Bachelor's degree required. Areas desired: Business, Industrial Engineering, Accounting and/or Management.
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Experience in a Regional Operations role that involved strategic operational planning and involvement.
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Proven experiencewith creating, improving and implementing systems/processes for work flow.
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Management experience of 15+ staff members of different experience levels.
*
Ability to interact with various customers (internal and external).
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Background in pharmaceutical protocol and long-term care facilities is strongly desired.
*
Experience with healthcare insurance billing management is strongly desired.
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Comprehensive knowledge of billing private insurance and associated regulations (e.g. Medicare Part D) is desired.
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Comprehensive knowledge of billing Medicare/Medicaid in multiple states (WA, OR, ID and CA) is desired.
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Effective verbal and written communication skills are a must.
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Minimal travel is required.