Job Detail

About Us

At Owl Western Pharmacy, we're leveraging 15 years of servicing the Long-Term Care community to pave a future defined by exceptional patient care and simplicity.

We are a closed-door, sterile compounding Long-Term Care Pharmacy servicing Skilled Nursing Facilities and Assisted Living Facilities.

Our Mission: To Navigate healthcare challenges with innovation and clarity, ensuring that every decision and action prioritizes compassionate patient care and customer experience.

Our Goal: Provide our partners with quick, personalized, and cost effective Long-Term Care Pharmacy solutions that help put patient care at the forefront of attention.

Job Overview

We're seeking detail-focused Long-Term Care Pharmacy Biller(s) to join our team. This position requires an understanding of pharmacy billing and reimbursement, as well as familiarity with various insurance payers, including Medicare, Medicaid, and private insurance.

Our LTC Pharmacy Billers have ownership of completing and ensuring end-to-end accuracy for their assigned Skilled Nursing or Assisted Living Facilities, ensuring that latest facility and patient information remains current, accurate, and confidential.

Core Responsibilities:

Claims Processing:

• Accurately enter and submit insurance claims for medications dispensed to LTC facilities (nursing homes, assisted living).
• Ensure proper coding and documentation for accurate reimbursement.
• Research and resolve claim denials and rejections from insurance companies.
• Appeal denied claims to secure reimbursement.

Accounts Receivable Management:

• Track and monitor outstanding claims.
• Follow up with insurance companies and facilities to resolve outstanding payments.
• Identify and address potential billing errors.
• Maintain accurate patient account records.

Prior Authorizations:

• Submit and manage prior authorizations from insurance companies for medications requiring approval (Major Insurances, both private and Government e.g. Medi-Cal, Medicare, etc.)
• Manage the prior authorization process, including obtaining necessary documentation and following up with insurance companies.

Data Entry and Maintenance:

• Accurately enter patient demographics, insurance information, and medication data into the pharmacy management system.
• Maintain accurate and up-to-date patient records.

Compliance:

• Stay informed about and comply with all relevant regulations and guidelines, including those related to HIPAA, Medicare Part D, and state regulations.

Intake Support:

• Support the team by taking incoming calls, answering questions, and helping those around you.

Pharmacy Technician License preferred but not required.

Experience with Pharmacy Management System DigitalRX is preferred.

Professional requirements

• Minimum of 1-2 years of experience in long-term care pharmacy billing.
• Ability to work independently and as part of a team.
• Knowledge of pharmacy billing and reimbursement practices, including prior authorization requirements. We provide training opportunities.
• Meets our professional but relaxed dress code and appearance standards.
• Proficiency in pharmacy software and billing systems.
• Participate in our Continuous Process Improvement Culture by communicating opportunities for improvement.
• Represent our organization in a positive and professional manner within working team, and in customer interactions.
• Always maintains patient confidentiality.

Come join our team as a Long-Term Care Pharmacy Biller, where you can make a meaningful impact on patient health outcomes, while developing your skills in a supportive environment.

Job Types: Full-time, Part-time

Pay: $22.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekends as needed

Work Location: In person