Pharmacy Operations Specialist
Remote, MA Remote US
- Minimum of a High School diploma or equivalent
- Two or more years of experience in a professional or pharmacy setting
- Customer Service/Call center experience
- Associate or Bachelor’s degree
- Previous experience in a managed care environment
The incumbent is responsible for coordinating all the functions and activities related to patient access including, but not limited to: front end customer service, patient registration, insurance/coverage verification, appointment scheduling, charge entry, billing and managed care, and a variety of administrative duties in support of department (such as coordination of physician credentialing, handling phones & mail, filling out forms, filing, photocopying, faxing, preparing letters, reports, etc.).
ESSENTIAL RESPONSIBILITIES / DUTIES:
Focuses on one or more of the following areas, and provides support as needed to optimize daily flow:
- Charge entry
- Batch controls
- Billing (TES) edits
- Hold bill edits
- Charge reconciliations
- Billing and managed care functions (including responding to billing inquires, corresponding with insurance carriers, and investigating discrepancies, etc.).
- Provides general administrative support to include, word processing, spreadsheets, presentation software to create and edit department documents and/or presentations.
- Provides physician and departmental support such as managing physician & manager calendars, scheduling physician & managers? administrative appointments, answering departmental calls, credentialing documents, etc.
- Reception & customer service
- Creating or verifying Master Patient Index (MPI) registration demographics
- Visit management appointment scheduling (including consults, tests, in-office procedures, follow-up visits and cross-booking interpreters, social services, radiology, etc.) insurance/coverage verification co-payment collection
- Front-end review and correcting registration & insurance edits
- Pre-authorization, referral coordination and referral reconciliation
- Referral work lists Provides a variety of administrative duties in support of the practice (such as handling phones & mail, filling out forms, filing, photocopying, faxing, preparing letters, reports, etc).
- Adheres to all RESPECT behavioral standards.