Pharmacy Business Coordinator - Home Infusion (Billing and Revenue Cycle)
Core
Conduct payer discussions, perform financial audits (CMS, 3rd party), manage prepayment claims, and handle revenue cycle operations for home infusion pharmacy services.
Role type
Pharmacy Business Coordinator (Billing and Revenue Cycle)
Builds
Revenue cycle compliance and accurate billing for home infusion patients
Domain
Healthcare / Pharmacy / Revenue Cycle Management
Required skills
Payer relations, claims adjudication, contractual claims processing, medical terminology, 340B Drug Discount Program compliance, financial education/counseling, insurance verification, pre-certification/authorization management, charge anticipation calculations, contract reconciliation, contract review and negotiation
Preferred skills
PTCB Advanced Pharmacy Technician Certificate, specialty pharmacy experience, knowledge of drug dosing/side effects/indications/contraindications, knowledge of pharmaceutical drug disbursal rules, knowledge of clinical procedures
Technologies
Registration/billing systems, database management tools
Responsibilities
Conduct payer discussions and resolve payment issues; perform in-house financial audits and CMS CERT/Fraud, Waste, & Abuse audits; manage prepayment claims and third-party payer compliance; verify insurance eligibility and benefits; calculate patient co-payments, deductibles, and co-insurance; arrange alternate payment methods for self-pay patients; maintain registration accuracy threshold of 98%; review and update pharmacy contracts to secure higher reimbursement rates; facilitate discussions with insurance companies to identify overpayments/underpayments; perform medical necessity screening; maintain database of pharmacy contracts.
Seniority
Individual Contributor, entry to mid-level