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, judgment, discretion, and knowledge of a substantial body of administrative or program principles, concepts, policies and objectives.

Duties

Reviews electronic records from the emergency room and outpatient clinics daily reflecting care patient provided and medication prescribed/dispensed. Receives the pharmacy prescription dispensing reports electronically via online billing system. Ensures that prescription 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. Research and follows-up on rejected claims online in order to ensure maximum reimbursement to the facility. Works with the various Pharmacy Benefits Managers help desks to fix rejects within specified time frames. This includes telephone contacts and any steps necessary for satisfactory resolution of the claim. Reviews, interprets, accurately fills individual prescriptions, performs the basic technical processes entailed in dispensing prescriptions. Demonstrates working knowledge of the hospital computer system. Demonstrates customer service skills while communicating effectively with medical professionals, other hospital staff and patients. Interviews patients and/or family member to obtain pertinent patient registration information. Obtains third party coverage information. Registers all data into the patient registration package.

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: 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: GS-7: Receives medication orders, abstract and interpret data from pharmacy records in preparation and submission of pharmacy point of sale by calculating the dosage in 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 Gallup Service Unit 516 E Nizhoni Blvd P O Box 1337 Gallup, NM 87301 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]