Position Summary:
Responsible for review, interpreting and posting of Pharmacy Benefit Manager payments. Payment posting is a data entry position in a high production-based environment with time sensitive deadlines. Accurate application of payments is needed and attention to detail.
Essential Functions of the Job:
- Reviews patient and prescription data in the pharmacy system.
- Reviews claim submission for accuracy.
- Review and Post payments in Pharmacy Benefit Manager portal.
- Verify Deposits in Pharmacy Benefit Manager portal.
- Download 835 files from Pharmacy Benefit Manager portal.
- Organize and upload 835s to Epic FTP folder.
- Load and post bank cash files.
- Performs accurate posting of payments and denials.
- Applies adjustments according to carrier’s adjudication and/or SYH posting procedures and contracts.
- Reviews and clears errors on payments.
- Coordinates the preparation of reports and written documentation, as required by the department.
Additional Duties and Responsibilities
- Follows established departmental policies and procedures, quality assurance program, safety, environmental and infection control standards.
- Enhance professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
- Review and submit prior authorizations as needed.
- Performs other related duties as assigned by the Director of Pharmacy or Pharmacy Business Supervisor.
Job Requirements
Education Required:
High School Diploma or GED equivalent.
Certifications/Licenses Preferred:
Current Pharmacy Technician license from CA Board of Pharmacy preferred.
Experience Required (Minimum level of experience):
Minimum 2 years with claim adjudication/billing experience.
Preferred:
2 years of relevant medication prior authorization experience preferred.
At least some familiarity with EPIC.
Verbal and Written Skills Required to Perform the Job:
Bilingual (English/Spanish preferred. Good oral and written communication.
Technical Knowledge and Skills Required to Perform the Job:
Ability to organize and prioritize work to meet deadlines. Good oral and written communication skills. Knowledge of MediCal, Medicare and commercial insurance regulations preferred. Knowledge of medical terminology and familiarity with Epic systems preferred.
Equipment Used:
Computer and pharmacy software system (Epic).
Working Conditions and Physical Requirements:
Prolonged periods of sitting using a PC and constant walking and standing. Lifting no more than 15 lbs. Driving and occasional travel to other sites may be required. The ability to follow directions correctly and accurately is a must.
Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
Skills Required
- High school diploma or GED equivalent
- At least 2 years of claim adjudication or billing experience
- Current Pharmacy Technician license from the California Board of Pharmacy
- At least 2 years of medication prior authorization experience
- Familiarity with Epic systems
- Bilingual English and Spanish communication skills
- Knowledge of Medi-Cal, Medicare, and commercial insurance regulations
- Good oral and written communication skills
- Ability to organize and prioritize work to meet deadlines
What We Do
San Ysidro Health is a community-focused healthcare organization providing safety-net care and services to people in need across San Diego County. Founded in a small three-room house in San Ysidro in 1969, it has grown to more than 50 clinic and program sites, supported by over 2,500 staff members. Its mission centers on dedicated, culturally responsive care for surrounding communities.
