Navajo Preference Employment Act : In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview:

The Pharmacy Collections Specialist is responsible for managing the accounts receivable process for medications dispense to oncology patients. The incumbent must have experience in medical billing and collections, as well as a strong understanding of insurance reimbursement processes and regulations related to oncology services. The incumbent will follow-up on outstanding patient accounts billed to pharmacy insurance carriers for pharmaceuticals provided to patients, and the resubmission of denied claims for payment processing. Will work closely with patients, physicians, and insurance companies to ensure that accurate and timely payments are received, outstanding balances are collected, and required reports are prepared. Duties also include the prior authorization of prescribed medications and assisting patients in enrolling into patient assistance programs. This position is in a pharmacy that services an ambulatory clinical setting for oncology patients.

Qualifications:

High School diploma or GED

Six-months experience in a pharmacy retail or healthcare setting and experience in pharmaceutical terminology, billing, and pharmacy operations

• Strong knowledge of medical terminology and procedures related to medical services
• Excellent communication skills, both verbal and written
• Ability to work collaboratively with a diverse group of individuals, including physicians, pharmacists, patients, insurance providers, and pre-authorization teams
• Strong organizational and time management skills
• Ability to work independently and manage multiple priorities
• Proficiency in medical billing software and other computer programs used for data analysis and claims tracking
• Knowledge of Windows based software applications, i.e., Word, Excel, Outlook
• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences.
• Completion of an above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC

Physical:

The work is primarily sedentary with the following physical requirements: ability to lift up to 10 pounds, walk for short periods of time, sit for long periods of time, stoop and pick up objects from the floor without restrictions, have full use of hands and arms for simple/firm grasping, fine manipulation, and use of keyboards, i.e., to operate office equipment such as computer, calculator, printer, fax, etc. Must have the ability for prolonged use of near vision, color vision, depth perception, seeing in fine details, hearing normal speech, hearing overhead pages over a loudspeaker, and utilize a telephone. May occasionally need to use far vision.

Mental:

Exercises initiative and judgment in deviating from existing department or corporation practices to resolve billing issues/concerns. Work is reviewed for conformance to policies, procedures, and practices relating to billing practices. Must have prolonged ability to cope with high level of stress; make decisions under high pressure; cope with anger/fear/hostility of others in a calm way; manage altercations; concentrate; handle high degree of flexibility; handle multiple priorities in stressful situation; demonstrate high degree of patience; adapt to shift work; and work in areas that are close and crowded. May frequently need to work alone.

May occasionally be exposed to infectious disease, chemical agents, dust, fumes, gases, extremes in temperature or humidity, hazardous or moving equipment, unprotected heights, and loud noises.

Responsibilities:

• Review and interpret insurance policies and regulations related to oncology therapy treatments to ensure compliance with billing requirements.
• Work collaboratively with the oncology team to ensure accurate and complete pre-authorization for oncology pharmaceutical treatments.
• Perform work consisting of examination for accuracy, adequacy of documentation or citation, compliance with regulations, and justification of claims and other requests for payment for oncology services provided by TCRHCC and reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medication dispensing.
• Ensure pharmaceuticals are billed according to Dispense-As-Written (DAW), Drug Utilization Review, Diagnosis, and Payer Format (BIN #) guidelines.
• Work with the Oncology Pharmacy staff to reconcile denied/rejected claims and manages and reconcile rejects through interpreting clinical messages, DUR specification codes, and append/amend claims for payment.
• Review patient accounts to determine the status of the account, making standard adjustments that require special analysis, prepare, and process a variety of documents necessary for the maintenance and follow-up of all outstanding pharmacy accounts.
• Research and follow-up on rejected claims for prior authorizations on-line to ensure maximum reimbursement to the facility in a timely and professional manner, and track telephone contacts, submission of supporting documentation, and any steps necessary for satisfactory resolution of the claim.
• Review and verify patient insurance coverage and eligibility for treatments as needed, and identify eligible patients for patient assistance programs, work with patients, providers, and patient assistance programs to ensure timely orders.
• Maintain documents of all activity related/performed on patient accounts in patient financial folder, documentation to include dates, telephone numbers, name or person contacted with the status of payment.
• Responsible for identifying patient accounts deemed non-collectable. Generate and maintain appropriate documents on such patient accounts and refer to Patient Financial Services for disposition.
• Prepare end of month and quarterly status reports that list amounts billed, collected, and not collected.
• Stays current with industry trends, changes to insurance policies, and other developments that may impact the collections process for oncology pharmaceutical therapy treatments.
• Ensure proper PPE is always used while on duty. Face surgical mask is to be work in all hospital areas. Proper handwashing is required. If water is not available, use hand sanitizer. Social distancing will be practiced by department.
• Proper PPE is used inside assigned Clinics or Units. NIOSH- approved N95 Masks filtering face piece respirator or higher, if available, this includes eye or face shields, gloves, and isolation gowns.
• Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. Complete provided training.
• Perform other related duties as assigned.