Specialty Billing Technician

Responsible for the accurate billing and collection of third-party and patient payments for products and services rendered.

• Submit timely, accurate invoices to payers for products and services provided.
• Determine quantities and prices for billed products and services.
• Verify services and products are authorized and that required documentation is on file.
• Ensure Medicare documentation is received from the medical provider and submitted appropriately.
• Review reports to maximize generic substitution opportunities.
• Manage and collect patient balances prior to prescription dispensing, or in accordance with company policy.
• Ensure all required billing documentation is complete and accurate prior to claim submission.
• Process reimbursement checks and payments in accordance with policy.
• Review price modify logs and ensure corresponding SDL claims exist.
• Research and resolve third-party chargebacks in a timely manner.
• Assist with third-party audits in accordance with company policy.
• Process and file SDL claims in accordance with company policy.
• Handle prescription exceptions, including prior authorizations, referrals, and copay assistance opportunities.
• Communicate proactively with patients and providers regarding referral and prescription status.
• Assist patients with enrollment in assistance programs, confirming eligibility and required reporting/documentation.
• Handle phone calls that do not require pharmacist attention, including calls to physicians and third-party payers.
• Maintain subject matter expertise in external billing practices, including third-party adjudications, prior authorization, and patient financial assistance programs, and coach pharmacy technicians and support staff.