Primary Responsibilities

Under general direction, the Billing Clerk ensures the efficient and timely billing process that includes Facility Statements, Medicaid of Texas, multiple Third Party PDP’s, processing and submitting Prior Authorizations to their respective party, nursing home and pharmacy training on our Pharmacy Prior Authorization procedures.  Pharmacy data entry and filing orders may also be required.

Essential Functions

Responsible for the completion of the billing process that includes Facility Statements, Medicaid of Texas, multiple Third Party PDP’s, Hospice, private pay and Medicare B billing and any other billing required. Responsible for submitting claims and following up with insurance companies. Prepare and submit clean claims to various insurance companies either electronically or by paper. Responsible for resolving and working Third Party Rejections; knowledgeable with the use of LTC overrides and submissions. Responsible for reconciling Prior Authorization paperwork from previous work day. Responsible for emailing facilities on an on-going basis concerning outstanding prior authorizations. Responsible for updating customer payer source on a daily basis. Responsible for training and implementing the use of Cover My Meds or desired system to process Prior Authorizations. Ensure compliance of all Short-Cycle regulations and submissions. Profiling and submitting claims to all our Hospice PBMs. Conduct self in accordance with SSP’s employee manual. Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations. Provide professional customer service to all customers. All other duties as assigned.

Pharmacy Technician Duties

Enter prescription orders into the computer. Create and update patient’s health and insurance information in the computer. Assist the pharmacist, under direct supervision, in the practice of pharmacy, in accordance with local, state, federal and company regulations. Communicate with insurance carriers to obtain payment for prescription claims. Complete weekly distribution center medication orders, place orders on shelves, and verify all associated paperwork. Assist the pharmacist with filling and labeling prescriptions. Prepare the pharmacy inventory. Screen telephone calls for pharmacist. Communicate with prescribers and their agents to obtain refill authorizations. Compound oral solutions, ointments, and creams. Prepackage bulk medications. Maintain an awareness of developments in the community and pharmaceuticals fields that relate to job responsibilities and integrate them into practice. Assist in training new employees. Assist other pharmacy technicians. Assist pharmacist in scheduling and maintaining workflow. Maintain knowledge of loss prevention techniques. Troubleshoot third party prescription claims questions with an understanding of on-line rejections and plan parameters. Ability to add, subtract, multiply and divide in all units of measure, using whole number, common fractions and decimals. Ability to compute rate, ratio and percent and to draw and interpret bar graphs. Follow established procedures concerning quality assurance, cost-containment, security of controlled substances and disposal of drugs and hazardous waste. Comply with Corporate Compliance Program activities which include, but are not limited to: proper documentation; accurate coding; safety in the workplace; treating others with honor and respect; eliminating harassment, abuse and intimidation; understanding and following our Code of Conduct; and reporting inappropriate behavior.