Pharmacy A/R & Call Center Specialist

Summary/Objective At Outer Cape Health Services, it is our very basic belief that it is people who have made Outer Cape Health Services? growth & success possible & that we have been fortunate in employing people who take pride in the services we provide. Our goal at OCHS is to employ those who (1) always meet or exceed OCHS? standards; & (2) care enough to ensure that whatever they do, they do well. Essential Functions Performs prescription claim reconciliation using established procedures, documenting properly in QS1 & other OCHS systems. Manages all live & desk audits for the Pharmacy. Prepares daily bank deposits. Updates & posts payments to NetRx. Sends pharmacy billing statements to patients as required. Performs internal audit functions for the 340B program. Manages inventory & invoicing. Works on payment appeals & denials. Follows up with insurance companies on incorrect payments. Ensure payments are posted to the correct patient accounts, any discrepancies are followed up & work with the accounting department on the month end AR balance to ensure the amount reported in the financial statements is accurate. Provide information for the year-end audit as requested by Finance Department. Keeps Pharmacy Director informed about audit & payment issues/projects. Mentors & trains other pharmacy staff on department workflows & QS1 functionality. Assists with Patient Assistance Programs, where applicable. Prepares prior authorization, via CoverMyMeds & communicate where needed with provider & patient. Performs other functions of the Pharmacy Call Center as required. Monitors fax inbox to ensure medication related faxes are handled in a timely manner. Prepares in accordance with pharmacy law & standards of pharmacy practice, outpatient RX?s to be dispensed after pharmacist approval. Provides exceptional customer service & accommodate customer needs in a timely, efficient, & caring manner. Prepares telephone encounter as needed to providers, pharmacy staff or nurse. Answers telephone inquiries about medications, referring callers to pharmacist when necessary. Performs duties assigned by a licensed pharmacist. Areas of work are checked routinely for maintenance of quality control. Work is conducted in accordance with generally accepted standards of practice following departmental procedures & policies as outlined in the department operations manual. Additional Duties Transporting equipment for sterilization between the same sites. In the absence of the Health Site Director, assume the responsibility of doing payroll & the collection of 9 12 19 provider time sheets in Health Center Core Competencies - Pharmacy functional knowledge, Ability to manage staff & pharmacy processes & to train & mentor staff Technical skills - computer/QS1 Analytical & problem-solving skills Education & Experience Registered & Certified Pharmacy Technician license 3 or more years of pharmacy or medical experience Knowledge of medical & pharmacy terminology An understanding of pharmacy computer system operations (hardware, software, & operating systems), contracting, billing, & pricing Excellent computer & customer service skills Able to work in a fast-paced environment Must be prudent, ethical, & credible & use good judgment. Effective communication skills & the ability to work collegially with a wide variety of professionals in a fast-paced health care setting Reasoning ability (logic) to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Maintain focus & exercise controls that will result in objectives being timely & adequately met. Preferred Qualifications, Education, & Experience Knowledge of & experience with QS 1 & eCW software Inventory & basic accounting knowledge See Physical & Mental Job Requirements:www.outercape.org/join-our-team/