I have extensive experience with various pharmacy billing systems, including Epic, AthenaHealth, and Medisoft. My role involved managing claims processing, ensuring accurate billing, and resolving any discrepancies. I am adept at navigating these systems to optimize billing efficiency and compliance with insurance regulations.

When faced with discrepancies, I first review the claim details to understand the issue. I then contact the insurance provider to clarify any uncertainties and gather necessary documentation. If adjustments are needed, I update the system promptly and follow up to ensure the claim is processed correctly. My approach ensures minimal impact on the pharmacy's cash flow and maintains good relations with insurers.

I employ a multi-step verification process to ensure accuracy. This includes double-checking patient information, verifying insurance coverage, and reviewing the prescribed medications against billing codes. Regular training on the latest billing regulations and software updates also helps maintain high accuracy standards. Additionally, I conduct periodic audits to identify and rectify any recurring errors.

I regularly attend webinars, workshops, and training sessions offered by industry experts and regulatory bodies. I also subscribe to relevant newsletters and journals to stay informed about the latest changes. This proactive approach ensures that I am always prepared to implement new regulations and maintain compliance in the billing process.

One challenging issue was a rejected claim due to a coding error. I investigated the error, identified the correct code, and resubmitted the claim. However, the insurer still denied it, citing a pre-existing condition exclusion. I then gathered medical records to prove the condition was unrelated and successfully appealed the decision, securing reimbursement for the pharmacy.