Electronic Data Interchange Specialist jobs in Fort Lauderdale, FL

Pharmacy Therapeutic Interchange Technician

WHO WE ARE
Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies across the country. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members.

OVERVIEW

The pharmacy therapeutic interchange technician is responsible for accurate formulary application and billing for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements.

RESPONSIBILITIES

• Communicates selected Therapeutic Interchange formularies and prior authorization criteria to external and internal staff.
• Communicates pharmacy benefit coverage and preferred product to facilities via phone, fax, email, or dashboard.
• Resolves pending therapeutic authorization changes in a timely manner to make the next run or escalates to Therapeutic Interchange Pharmacist for an alternative intervention.
• Knowledge of Third Party Billing and claim resolution and adjudication
• Knowledge of FFS and PPS Billing
• Experience with census balancing and payor verification
• Verify Insurance/Medicaid coverage
• Knowledge of Dual Coverage, MCR D, and Commercial Plans pertaining to Long Term Care
• Assist with all customer billing inquiries in a courteous and professional manner
• Enter fees and charges in Framework LTC
• Follow all applicable government regulations including HIPAA
• Comply with departmental policies regarding safety, attendance, and dress code
• Overtime, holidays, and weekends may be required and/or expected
• Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Other duties as deemed necessary by Billing Manager

QUALIFICATIONS

• High School diploma or equivalent
• Registered Pharmacy Technician experience preferred.
• Expert knowledge of Sig codes and the ability to calculate accurate days supplies of billed medication.
• Two (2) years’ pharmacy billing experience required (long-term care preferred)
• Framework LTC & General computer knowledge & 10-key Number Entry preferred
• Able to read, write, speak and understand the English language
• Able to work in a fast-paced environment
• Basic computer knowledge skills required
• Basic math and analytical skills
• Proficient in Microsoft Word, Excel, and Outlook required
• Good organization/Attention to detail
• Reliable
• Able to work various shifts and days
• Adaptability to an ever-changing environment

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
• May be necessary to work extended hours as needed
• May lift and/or move up to 50 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

We provide qualifying full-time employees with 23 PTO (Paid Time Off) days annually. PTO is used for holidays, vacation, sick leave, and personal leave. Each quarter eligible employees may submit up to 16 hours of unused PTO for payout.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.

BENEFITS – for full time employees

• Medical, Dental, and Vision insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Company Paid Life insurance
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program