Job Details

Position Summary

The Pharmacy Operations department provides a variety of services and customized patient care to help manage patients' medication needs. The Pharmacy Operations team works with patient's insurance companies, submits prior authorization requests, patient assistance program applications and assists in‑house pharmacies addressing patient requests. The Pharmacy Billing Coordinator will be responsible for completing claims reviews, reconciliation of claims, and Pharmacy Benefit Manager (PBM) payments posting.

Essential Functions of the Job

• Reviews patient and prescription data in the pharmacy system.
• Reviews claim submission for accuracy.
• Review and posts payments in Pharmacy Benefit Manager portal.
• Verify deposits in Pharmacy Benefit Manager portal.
• Downloads 835 files from Pharmacy Benefit Manager portal.
• Organize and upload 835s to EPIC File Transfer Protocol (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.
• Removes 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.
• Reviews and submits prior authorizations as needed.
• Performs other related duties as assigned by the Director of Pharmacy and/or Pharmacy Business Services Supervisor.

Job Requirements

Education Required:

• High School Diploma or GED equivalent.

Experience Required:

• Minimum of 2 years with claim adjudication/billing experience.

Certifications Preferred:

• Current Pharmacy Technician license from CA board of Pharmacy preferred.

Verbal and Written Skills Required to Perform the Job:

• Bi‑lingual (English /Spanish speaking) preferred.
• Excellent oral and written communication skills.

Technical Knowledge and Skills Required to Perform the Job:

• Ability to organize and prioritize work to meet deadlines.
• Ability to follow directions correctly and accurately.

Equipment Used:

• PC, Microsoft Suite and Pharmacy Software System (EPIC).

Working Conditions and Physical Requirements:

• Prolonged periods of sitting using a PC.
• Lifting no more than 15 lbs.
• Driving and occasional travel to other sites may be required.

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.