Pharmacy Technician-Billing

Closing Date: March 02 2026 @ 4:00 P.M.(MST)

Salary Range: Dependent on Experience (DOE)

**APPLICANT MUST HAVE A VALID UNRESTRICTED INSURABLE DRIVERS LICENSE**

**RESUMES AND REFERENCES ARE REQUIRED**

ESSENTIAL DUTIES FUNCTIONS AND RESPONSIBILITIES

• Reviews electronic records from outpatient services daily reflecting patient care provided and medication prescribed/dispensed.
• Receives the pharmacy prescription dispensing reports electronically via online billing system. Determines if the prescription written by the provider is billable as defined by FDIHB guidelines and inputs data into the system accordingly. Verifies prescription amount dispensed by reimbursement by Pharmacy Benefits Managers.
• Ensures that prescriptions dispensed are entered into the system with the correct brand name or generic name for this information is the key to the charge generated per visit and maintained in the accounting records.
• Requests and obtains prior authorization for various pharmaceutical products from insurance companies. Receives and completes authorization forms providing all data required obtains signatures and returns as needed for processing of collection.
• Contacts the healthcare provider for additional information when services rendered to patient and prescription written for the patient are not clear or when more details are needed to complete the forms for the episode of care.
• Retrieves medical records. Researches patient records reconstructs incorrect or missing medical information required to prepare a valid insurance billing when data received is incomplete.
• Provides training to patient registration staff to assure that necessary data is entered into the registration package to identify insurance and benefits to start billing activities into the on-line billing system. Researches new insurance registrants for appointment history report to capture new and old billable visits. Calls insurance carriers to obtain overwrites for old visits.
• Analyzes maintains and directs the total billing operation for pharmacy point-of-sale programs and acts as an advocate for FDIHB in the collection of Alternate Resources.
• Researches and follows-up on rejected claims online in order to ensure maximum reimbursement to the facility. Works with the various Pharmacy Benefits Manager help desks to fix rejection within specified time frames. This includes telephone contacts and any steps necessary for satisfactory resolution of the claim. Documents all information in the patients medical chart RPMS and online system package.
• Prevents occurrences for orphan visits by means of creating an administrative billing. Creates a pharmacy visit PCC a record source document used to record patients diagnoses and services rendered and reentered into the online billing system for another attempt to recover collections due the facility. Follow up as needed to ensure maximum allowable amounts are collected.
• Develops and maintains files for the tracking of billing and reimbursement. Initiates inquiries either telephonically or by any viable means of written correspondence with insurance companies after pre-established time frames in order to determine why claims were rejected.
• Maintains records and files in accordance with applicable regulations and guidance. Responsible for maintenance of general files of directives instructions regulations notices and correspondence related to Pharmacy Benefits Manager programs. Ensures there is documentation of all action(s) taken for adequate audit trails. Provides documentation to the insurance companies when requested for an audit.
• Maintains records of each claim billed detailing history noting what action was taken on each claim; and coordinates with Patient Accounts billing technicians to record the amount collected and percentage paid; the amount resolved as invalid billings; and the final account disposition.
• Maintains online billing accounts to ensure validity of patient charges which constitute the major portion of the hospital accounts receivable. Reimbursements from these accounts are budgeted as a portion of the hospital operating fund. Maintains the interface between the various billing software and the RPMS system. Processes payments received by pulling billing for accounts verification purposes making appropriate annotations and submitting to the collection clerks.
• Maintains and updates Pharmacy Benefit Managers contracts. Works with designated personnel in obtaining billing agreements completing billing agreements and submitting to designated personnel. Provide follow-up and tracking of billing agreements including calling vendors to identify status of agreements.
• Serves as a technical resource for the online billing system program provides orientation and ongoing training to personnel.
• Responds to third party requirements on post-payment reviews exclusions denials and appeals. Actively performs audits and medical reviews to ensure documentation and accountability on all health insurance claims submitted for payment by conducting random sample reviews of claims and medical records.
• Performs qualitative and quantitative analysis on the medical records to ensure it contains proper documentation in accordance with regulations including proper diagnoses healthcare provider original signatures(s) accurate dates of medical care services and that primary care providers are in compliance with attestation and billing requirements.
• Reviews interprets and accurately fills individual prescriptions performs the basic technical processes entailed in dispensing prescriptions. Demonstrates working knowledge of RPMS Pharmacy Package and hospital computer system.
• Demonstrates customer services skills while communicating effectively with medical professionals other hospital staff and patients.
• For medication refills the technician provides independent patient medication counseling including verification of patient identification and verification of patient medication use answering specific medication questions and eliciting medication related problems that may require a pharmacist consultation.
• Participates in staff meetings and continuing education programs.
• Helps maintain the pharmacy drug file in the computer system for billing purposes updating National Drug Code (NDC) and pricing information.
• Returns medication to stock and submits proper documentation to the online billing.
• Prepares sterile solutions in the pharmacy utilizing scrupulous aseptic technique. Receives and reviews physician orders for intravenous solutions checking with the pharmacist if discrepancies such as incomplete or unusual dose orders are noted. Calculates and converts to proper weight measures the amount of drug needed for the IV admixture and sets up the necessary drugs and solutions.
• Based on substantial knowledge and familiarity with wide range of pharmaceuticals stocked in the pharmacy the technician answers questions from physicians nurses and other staff on availability of specific items (e.g. drugs in stock new drugs on order and dosage forms available in the pharmacy). Judgmental or unfamiliar questions or problems are referred to the pharmacist.
• Performs inventory and places order based on PAR levels. Prepares and submits order to review through use of hand held device. Receives and stocks order with appropriate documentation and rotation of stock. Assures that medication stocks are rotated and are stored under appropriate conditions. Orders supplies and IV solutions from supply services through their system. Observes policies procedures and guidelines with respect to controlled substance inventory.
• Interviews and patients and/or family members to obtain pertinent patient registration information (i.e. demographic and alternate resource information). Obtains third party coverage information (i.e. Medicare Medicaid and private insurance). Works with patient registration to ensure all data is updated.
• Receives and validates insurance registration information provided at the time of the patients visit and other beneficiaries of the patients insurance. Contact insurance companies to verify insurance coverage amount of coverage existing rules and regulations pertaining to patients policy. Determines the type of policy (i.e. Medicare Tricare Supplement Employer Group Individual Indemnity or HMO) and its application to the existing third party collection guidelines.
• Explains and clarifies the importance of obtaining third party information. Explains options entitlements billing procedures benefits and rights. Provides information on the process of online billing system its benefits and how reimbursement from these collections are budgeted as a portion of the hospital operating fund.
• Periodically liaises with patient access representative medical support assistants and health information technicians to provide initial or refresher training on their responsibilities to collect insurance information from beneficiaries at the point of service.
• Acts as a liaison with FDIHB and private insurance companies in order to inform them of billing methods and regulations.
• Explains and answers questions regarding the online billing system to patients physicians pharmacists insurance carriers other facilities and federal/state agencies (i.g. Medicare/Medicaid).
• Monitors the patient data input into the RPMS system. Coordinates corrections or changes to the patient data with the patient registration office and medical records. Assurers the accuracy of patient data so that correct billing documents are produced. Locates discrepancies determines source of error and takes necessary remedial action. Ensures that accounts are established for non-beneficiaries in RPMS and the patients are billed appropriately. Coordinates with other work units to resolve problems pertaining to the online billing system/Pharmacy Benefits Manager Program.
• Performs other duties as assigned.

MANDATORY MINIMUM QUALIFICATIONS

Experience: One (1) year of direct work experience.

Education: High School Diploma or Equivalency (HSE).

Pharmacy Technician Certification Board (PTCB) Certificate.

Must obtain state licensure (AZ or NM) within a month of date of hire.

Please email current certificate of Indian blood (CIB) valid insurable drivers license high school diploma and college degree or transcripts to

NAVAJO/INDIAN PREFERENCE

FDIHB and its facilities are located within the Navajo Nation and in accordance with Navajo Nation law has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy applicants who meet the minimum qualifications for this position and who are enrolled members of the Navajo Nation will be given primary preference in hiring and employment for this position and members of other federally-recognized Indian tribes will be given secondary preference. Other candidates will be considered only after all candidates entitled to primary or secondary preference have been fully considered.

Required Experience:

IC