Supervisor of Referral & Billing Services

Portland, OR, United States

As we continue to grow, we are seeking a Supervisor of Referral & Billing Services to join our award-winning specialty pharmacy team.

About Ardon Health

At Ardon, we are passionate about our mission to inspire people and improve lives through the delivery of high-quality, compassionate healthcare services. Our innovative work environment in Portland, Oregon, centers around uplifting collaboration with our employees as we care for patients. Our commitment to cultivating talent and fostering growth within our organization keeps Ardon ranked among the top 100 companies to work for in Oregon.

*Recognized as a Top Workplace by the Oregonian in 2021 and 2022*

Our specialty pharmacy

Our state-of-the-art specialty pharmacy provides medications that are often used to treat complex or rare conditions. We deliver services to enhance the patient experience within the comfort of their home. We remove barriers to care and provide patients with the education, clinical care and supportive services they need on their treatment journey. We work to build trusted relationships and to be a resource where patients can turn for help.

What it’s like to work with our team

Our progressive work environment embodies the notion that life is meant to be shared and lived well, through hard work, compassion, and camaraderie. Together, we e njoy team meals and celebrate events and company milestones. Employees like to relax in our lounge equipped with amenities that promote wellness and fun. We volunteer to support patient advocacy organizations within our community. Our employee-run DEI Group is dedicated to diversity and inclusion.

To learn more about our team and what we do , watch our video at https://vimeo.com/320864889 .

Join us!

Do you want a dynamic career opportunity where you can make a difference? Explore the potential of your pharmacy experience in an elevated role.

We are recruiting a Supervisor of Referral & Billing Services to join our team of health care professionals. As a Supervisor of Referral & Billing Services, you will provide leadership to all processes related to billing, insurance, and referral management and corresponding teams. This position manages departmental staff and will direct team resources to ensure timely, high-quality completion of work. This position is responsible for troubleshooting departmental issues, investigating solutions, and addressing escalated inquiries. The Supervisor of Referral & Billing Services maintains knowledge and awareness of billing standards, best practices, and applicable compliance and accreditation requirements, and provides support as needed.

Job type: Full-time

Pay range: $64,700-$80,900 annually depending on experience.

Benefits:

Competitive pay

Flexible PTO and paid company holidays

Medical, dental, vision, disability and life insurance

401(k) match

Position responsibilities:

Continuously assesses workflows to manage the needs of patients and the organization. Plans, prepares, and devises work schedules according to budgets and workloads. Provides day-to-day leadership and guidance to the Billing and Resource Teams to successfully achieve patient service goals.

Selects, trains, develops, evaluates, and motivates staff for the successful performance of the department and achievement of company objectives.

Monitors staff members’ performance. Provides effective two-way feedback to motivate high performance and a productive environment.

Develops and manages departmental reports for volume, service levels, productivity, and other markers. Monitors and measures against markers.

Communicates items of potential operational impact to leadership and external partners as appropriate. Coordinates responses to escalated payer inquiries and communicates escalated patient needs to payers, with guidance from operational leadership.

Responsible for application tasks, including but not limited to:

Processing incoming documents

Maintaining patient records

Performing benefits investigation

Loading insurance information

Performing prescription data entry

Processing prescriber refill requests

Processing prior authorization notices

Performing and reviewing claim submission and reversal

Addressing billing exceptions

Support accounts receivable processing needs

Troubleshoots adjudication issues and is well versed in the nuances of insurance billing and benefits investigation.

Fields multi-department email requests and addresses issues or facilitates routing to alternate department.

Interacts with all areas of Ardon Health to correct or enhance specific implementation activities as identified through customer service issues (billing, coordination of benefits, payment processing), observation, and communication with patients or group contacts.

Maintains patient safety as a top priority.

Assists with testing new processes, developing training and operational materials, and writing business requirement documents.

Creates and maintains processes related to organization, maintenance, and application of the company’s network of insurance plans as well as applicable manufacturer copay assistance and foundation services. Participates in network enrollment review processes.

Maintains active Oregon license. Informs supervisor within 1 business day (and Oregon Board of Pharmacy within 10 days) of any arrests, convictions, suspected or known violations of law, or any other conduct that might affect or has affected license status. Reports to Oregon Board of Pharmacy within 15 days any changes to name, residence address, or employment.

Actively participates and provides support as needed to leadership and quality program staff to ensure activities related to the company’s quality management program and quality improvement activities maintain priority focus and are effectively executed. This may include but is not limited to activities that promote objective and systematic measurement, monitoring, and evaluation of services and defined Quality Improvement Projects (QIPs) that may result from such efforts.

Complies with the company’s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities.

Performs other duties and responsibilities as assigned.

Required skills:

Education and experience

Required:

High school diploma or GED.

Active Oregon Pharmacy Technician License. A Certified Oregon Pharmacy Technician License will be required prior to expiration of existing Oregon license or as required by the Oregon Board of Pharmacy.

Preferred:

Demonstrated leadership and management skills.

Experience in billing prescription medications through both pharmacy and medical benefits.

Knowledge of Medicare and Medicaid billing requirements.

Prior work experience in a customer service setting.

A minimum two years’ experience in a medical office, health insurance plan, or pharmacy.

Physical and mental functions and activities

Must be able to be innovative, solution-oriented and to strive for best practices.

Must be able to shift direction based on business needs while successfully remaining focused.

Must demonstrate excellent customer service skills and the ability to express compassion and empathy.

Must be able to multi-task and work in a fast-paced environment.

Must demonstrate teamwork and a positive outlook.

Must have excellent verbal, written, and interpersonal communication skills.

Must be able to express oneself, detect, perceive, observe, and assess information exchanged in a variety of communication methods.

Must be able to demonstrate proficiency with computer applications.

Must be able to work independently as well as part of a team.

Must be able to provide timely, accurate, courteous, and concise responses to escalated inquiries in person, by telephone, or by correspondence.

Must have strong knowledge of prescription intake requirements, insurance plans, patient assistance programs, and foundation support with the ability to assist patients to coordinate insurance benefits and/or explore options for copay and other financial assistance.

Must be able to manage and support special projects as assigned.

Must be able to manage escalated issues that occur within pharmacy software system work queues.

Must be able to assist in communicating and maintaining relationships with outside vendors.

Must be able to understand and interpret complex claims adjudication issues with Pharmacy Benefit Management organizations, insurance plans, and Patient Assistance Programs.

Must be able to accurately utilize applicable computer software and equipment for pharmacy claims processing.

Working conditions

Work is performed primarily at a desk, with extensive keyboard work in stationary position.

Business needs may occasionally require work in excess of 40 hours per week, including work outside of standard work week.

Contact with others:

Internally with Ardon employees across multiple departments.

Externally with patients, prescribers, prescriber agents, clients, third-party payers, HUBs, and manufacturers.

Our ideal candidate has:

Strong communication and interpersonal skills.

Ability to effectively collaborate in a team setting.

Proficiency in standard workplace software and/or information management applications.

Prior experience working in a pharmacy or healthcare setting.

Ability to navigate computer applications.

Ability to work in a fast-paced environment.

Knowledge of pharmacy benefit investigation, prior authorization support, and patient financial assistance connection.

Prior experience working with physicians, nurses, or other healthcare professionals.

Ardon Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual identification or orientation, national origin, marital status, disability, veteran status or any other status protected by law.

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