Scope of Position
Under the direction of the Finance Manager and the Associate Director of Retail Pharmacy , assists with accounting, auditing, adjudicating and billing claims within the pharmacy computer system and payroll activities. Demonstrates a high level knowledge in medication billing including relevant laws and regulations. Collect, compile and verify financial information to assist Finance Manager in the preparation of financial reports. Demonstrates ability to work as a member of a team. As a pharmacy technician must participate in continuing educational opportunities to meet the annual competency requirements. Participates in continual training opportunities provided by department to develop ongoing skills in other areas of the pharmacy. Complies with all rules and regulations of the hospital and pharmacy department.
Position Summary
This position assists the Finance Manager and Specialty Retail Pharmacy Managers finance related activities. These activities include but are not limited to manually billing medication claims, preparing documentation for third party audits, processing third party payments received by the pharmacy, reconciling financial discrepancies, reviewing cost saving opportunities for the cost center and editing and submitting employee payroll for the cost center. This position is also responsible for supporting initiatives of area supervisors and managers.
Duties and Responsibilities
75% Financial Activities
Under the direction of the pharmacist, in coordination with other technicians, and according to applicable state and federal law, technicians will:
A. Maintain knowledge of Medicare billing
B. Adjudication and reversal of claims within the pharmacy computer system
C. Prepare and complete required documentation for Medicare, Medicaid and PBM prescription audits
D. Complete and file CMS 1500 claim forms
E. Maintain records and process all manually billed grant claims
F. Review and submit underpaid MAC claims for review via online portal
G. Review and investigate POS balance reports to ensure accuracy
H. Process checks received third party payers and customers
2 of 4
I. Edit and submit employee payroll for Outpatient Pharmacy cost center
J. Assist Financial Manager and Specialty Retail Pharmacy Managers with projects
K. Interact with patients, physicians, nurses, other allied health professionals and pharmacist staff in a courteous and professional manner
L. Demonstrate the ability to work as a member of a team by exhibiting good interpersonal skills and remaining flexible and open-minded
10% Distributive Practice Activities
Under the direction of the pharmacist, in coordination with other technicians, and according to applicable state and federal law, technicians will:
A. Prepare and package complex injectable, oral, topical, ophthalmic, and rectal medication dosage forms for patient use and in research protocols according to procedures learned through on-the job training and educational programs
B. Using proper technique, compound specialty products for patient use
C. Prepare self-administered medications for patients to improve their understanding of their medication regimens
D. Generate medication labels
E. Coordinate and deliver medications and supplies to nursing units and other areas in a timely and accurate manner to ensure optimal patient care
F. Triage new medication orders, and enter orders into the pharmacy computer system for pharmacist verification and approval
G. Answer the phone and coordinate efficient operations
H. Maintain accurate and appropriate dispensing records and proof of delivery records
I. Maintain appropriate medication inventory levels to ensure uninterrupted service to all customers
J. Inspect medication storage areas for expired, unusable, or unsecure medications (pursuant to JCAHO and state board of pharmacy standards)
K. Performs quality assessment activities and procedures to ensure optimum pharmaceutical services.
L. Interact with physicians, nurses, and other allied health professionals in a courteous and professional manner
M. Demonstrate the ability to work as a member of a team by exhibiting good interpersonal skills and remaining flexible and open-minded
N. In addition to Pharmacy Technician duties, resolves complex problems related to prescription inquiries. Responsible for advising Pharmacy Technician on order fulfillment and related duties. May be responsible for implementing inventory control procedures and ordering merchandise within regulatory guidelines
O. Provides technical guidance pertaining to pharmacy technician procedures and problems. Acts as a resource for direction and guidance for less experienced staff
P. Interacts with patients over the phone or in person to coordinate delivery of medications to patients home or appointment
Q. Adjudicate third part claims and resolve claims issues
5% Productivity Management
A. Maintain organized workspace to help foster efficient operations
B. Proactively seek solutions to customer problems encountered both inside and outside of the department
C. Maintain self-productivity
D. Show attention to detail, accuracy, and thoroughness in an effort to continually improve quality
E. Present ideas to managers for process and quality improvement
F. Support team initiatives
G. Respect the authority of the managers
H. Perform tasks efficiently and within established time standards
I. Manage time wisely and demonstrate the ability to prioritize assigned tasks
J. Use time wisely and look for activities that need to be performed
K. Respond positively within a dynamic work environment
10% Teaching/Training/Educational Activities
A. Satisfy all departmental, medical center and University required training requirements
B. Meet annual competency requirements for department
C. Be committed to personal growth and development
D. Complete pharmacy technician training and educational programs.
Organizational Expectations
Practices within the Medical Center's policies and procedures. Adheres to the Intensive Caring Value statements as demonstrated through positive patient/guest relations, positive and effective interactions with staff, and formulating and meeting developmental
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goals.
Minimum Qualifications
For Hire: High school diploma, strong science background, knowledge of the metric system and good math skills. Familiarity with pharmacy terminology, 1-3 years experience as pharmacy technician and 6-12 months experience of Medicare and PBM billing. Strong computer skills including knowledge of Excel and experiencing using Electronic Medical Records reporting tools. Must possess analytical and problem solving skills and demonstrate the ability to work both independently and in a team environment. Must complete Pharmacy Technician Certification Board (PTCB) certification within 180 days of hire, unless current PTCB certificate is in place upon hire. Registered in the State of Ohio as a Certified pharmacy technician, Registered pharmacy technician, or eligible for registration as a Pharmacy technician trainee. If not already registered as a Certified pharmacy technician, or Registered pharmacy technician, must complete registration as a pharmacy technician trainee within 15 days of hire. Must achieve registration as a Certified pharmacy technician within 180 days of hire. If current PTCB certificate is in place upon hire, but not already registered, must complete registration as a pharmacy technician trainee within 15 days of hire, and achieve registration as a certified pharmacy technician within 60 of start date. Actively licensed Ohio pharmacy interns will not be required to register as Certified pharmacy technicians.
On going: PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment.

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