Financial Accounts Technician - Outpatient Pharmacy Electronic Claims Coordinator
The Financial Accounts Technician (Outpatient Pharmacy Electronic Claims Coordinator) is responsible for performing billing and insurance verification functions as they pertain to the ePharmacy program for all medical centers serviced by the CPAC. Duties include, but are not limited to:
Performs claim submission functions related to prescription drugs provided for beneficiaries with reimbursable prescription insurance; Provides expertise on healthcare related claim submission actions, ensuring claims are submitted in various formats in compliance with the specific requirements of the appropriate insurance carrier; Reviews returned/rejected claims for reason of rejection or denial, takes appropriate corrective action, and resubmits claims for payment; Researches and processes refund requests from third-party pharmacy payers; Tracks third-party payments posted to suspense and coordinates appropriate and timely resolution of payments with other departments (Revenue Accounting, Accounts Management, Cash Management); Solves problems that may arise with electronic submission of pharmacy claims, including insurance verification, patient accounts and data validation; Receives and responds to a variety of written and oral communication generated by third-party pharmacy payers; Ensures proper follow-up procedures with phone calls to health insurance companies, accessing the company's online database and/or submitting letters to the insurance company and patients; Contacts and pursues third-party payers to expedite collections; Prepares statistical reports as required; Performs other duties as assigned. Work Schedule:
Monday - Friday, 8:
00am - 4:
30pm Recruitment & Relocation Incentives:
Not authorized Financial Disclosure Report:
Not Required To qualify for this position, applicants must meet the Specialized Experience requirement as stated below:
SPECIALIZED
Experience:
Requires at least one (1) year of specialized experience equivalent to the next lower grade level (GS-5) in the Federal service, that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of the position to be filled. Specialized experience includes:
maintaining healthcare related accounts receivable files; tracking third-party health insurance payments; communicating with third-party payers to expedite collections; resolving issues with electronic submission of pharmacy claims, including insurance verification, patient accounts and data validation. (Resume(s) must clearly support the required experience. We will not make assumptions) You will be rated on the following Competencies as part of the assessment questionnaire for this position:
Accounting OperationsAnalytical ThinkingCustomer ServiceInsurance IMPORTANT:
A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https:
//www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
Estimated Salary: $20 to $28 per hour based on qualifications.
Performs claim submission functions related to prescription drugs provided for beneficiaries with reimbursable prescription insurance; Provides expertise on healthcare related claim submission actions, ensuring claims are submitted in various formats in compliance with the specific requirements of the appropriate insurance carrier; Reviews returned/rejected claims for reason of rejection or denial, takes appropriate corrective action, and resubmits claims for payment; Researches and processes refund requests from third-party pharmacy payers; Tracks third-party payments posted to suspense and coordinates appropriate and timely resolution of payments with other departments (Revenue Accounting, Accounts Management, Cash Management); Solves problems that may arise with electronic submission of pharmacy claims, including insurance verification, patient accounts and data validation; Receives and responds to a variety of written and oral communication generated by third-party pharmacy payers; Ensures proper follow-up procedures with phone calls to health insurance companies, accessing the company's online database and/or submitting letters to the insurance company and patients; Contacts and pursues third-party payers to expedite collections; Prepares statistical reports as required; Performs other duties as assigned. Work Schedule:
Monday - Friday, 8:
00am - 4:
30pm Recruitment & Relocation Incentives:
Not authorized Financial Disclosure Report:
Not Required To qualify for this position, applicants must meet the Specialized Experience requirement as stated below:
SPECIALIZED
Experience:
Requires at least one (1) year of specialized experience equivalent to the next lower grade level (GS-5) in the Federal service, that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of the position to be filled. Specialized experience includes:
maintaining healthcare related accounts receivable files; tracking third-party health insurance payments; communicating with third-party payers to expedite collections; resolving issues with electronic submission of pharmacy claims, including insurance verification, patient accounts and data validation. (Resume(s) must clearly support the required experience. We will not make assumptions) You will be rated on the following Competencies as part of the assessment questionnaire for this position:
Accounting OperationsAnalytical ThinkingCustomer ServiceInsurance IMPORTANT:
A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https:
//www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
- Department:
0503 Financial Clerical And Assistance - Salary Range:
$38,921 to $50,598 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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