The primary purpose of this position is to abstract and interpret data from pharmacy records in preparation and submission of pharmacy point of sale billing claims. The work requires analytical ability, judgement, discretion, and knowledge of a substantial body of administrative or program principles, concepts, policies, and objectives. This position is located at Chinle Service Unit, Division of Clinical Services, Pharmacy Department, Chinle, Arizona.

Duties

Receives the pharmacy prescription dispensing reports electronically via on-line billing system. 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. Reviews electronic records from the emergency room and outpatient clinics daily reflecting patient care provided and medication prescribed and dispensed. Requests and obtains prior authorization for various pharmaceutical products from insurance companies. Researches and follows-up on rejected claims on-line in order to ensure maximum reimbursement to the facility. Develops and maintains files for the tracking of billing and reimbursement. Maintains records of each claim billed detailing history, noting what action was taken on each claim and coordinates with Business Office Billing Technicians to record the amount collected and percentage paid. Process payments received by pulling billing for accounts verification purposes, making appropriate annotations and submitting to the collection clerks. Responds to third party requirements on post-payments reviews, exclusions, denials and appeals. Provides independent patient medication counseling, including verification of patient identification and verification of patient medication use. Prepares sterile solutions in the pharmacy utilizing scrupulous aseptic technique. . Receives and validates insurance registration information.

Requirements

Qualifications

To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. 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; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. MINIMUM QUALIFICATIONS: GS06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: abstract and interpret data from pharmacy records in preparation and submission of pharmacy point of sale GS07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: receive medication orders, abstract and interpret data from pharmacy records in preparation and submission of pharmacy point of sale by calculating the dosage and dispense the medication. Process claims to health insurance carriers for cost. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

There are no education requirements.

Contacts

• Address Chinle Service Unit PO Drawer PH Chinle, AZ 86503 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]