Pharmacy Accounts Receivable Specialist - Healthcare

The Pharmacy AR Specialist is responsible for managing the accounts receivable (AR) processes related to buy-and-bill medications. This includes verifying insurance coverage, submitting claims, resolving billing discrepancies, and ensuring timely reimbursement from payers. The role requires collaboration with pharmacy teams, healthcare providers, and insurance companies to streamline the revenue cycle and minimize denials.

• Track claims to ensure timely processing and reimbursement.
• Identify and address claim rejections and denials promptly.

• Reconcile payments and outstanding balances for buy-and-bill medications.
• Maintain detailed records of payer communications and payment status.
• Follow up on unpaid or underpaid claims.

• Compliance and Documentation:
• Ensure claims comply with payer policies, coding standards, and regulations.
• Maintain organized and accurate documentation for audit purposes.

• Identify opportunities to optimize the buy-and-bill billing process.
• Implement solutions to enhance efficiency and reduce denials.

• Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements.
• Ability to communicate effectively, both orally and in writing
• Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR).
• Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures.
• Proficiency in insurance verification, prior authorization, and AR follow-up.
• Attention to detail, organizational skills, customer service orientation, and analytical thinking.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations,organizational policy, and accreditation/compliance requirements.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.

• High School Diploma or equivalent
• College degree preferred

• 2 years medical billing, pharmacy billing, or revenue cycle management, particularly in buy-and-bill processes.