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Therapeutic Interchange Billing Specialist Jobs in Fort Lauderdale, FL at Ltc Pharma Hldg Llc

Title: Therapeutic Interchange Billing Specialist

Company: Ltc Pharma Hldg Llc

Location: Fort Lauderdale, FL

Therapeutic Interchange Pharmacy Billing Specialist

WHO WE ARE Polaris Pharmacy Services is an industry leader in long-term and post-acute care pharmacy.

The Therapeutic Interchange Pharmacy Billing Specialist is responsible for accurate formulary application and billing for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements.


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


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
Able to work various shifts and days
Adaptability to an ever-changing environment

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 25 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

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.

Please note we are a long-term care pharmacy open 24-hours a day, 7 days a week.


Medical, Dental, and Vision Insurance
Life Insurance
Short-term and Long-term disability

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About Ltc Pharma Hldg Llc