Billing Specialist I

Guardian Pharmacy Services Management•Pink Hill, NC

3d•Onsite

About The Position

The Billing Specialist I processes customer bills and insurance claims accurately and on time, assisting with daily and month-end billing functions, procedures, and reporting. The role provides customer service to patients, caregivers, medical providers, and insurance carriers, and supports billing operations for assigned facilities. It requires handling patient and insurance information, resolving billing and prescription claim issues, maintaining audit documentation, and following applicable regulations, including HIPAA. The position works in an office environment and requires desk work, effective interaction with others, the ability to manage conflict and stressful situations, and flexibility in working hours. The employee may rotate through other departments to learn their workflows and may take on other duties as assigned.

Requirements

High school diploma or GED.
At least 1 year of related experience.
Pharmacy Technician license, certification, or registration as required by the state; national certification (PTCB) is preferred and may be required depending on the pharmacy.
Advanced computer skills.
Ability to work independently and meet deadlines.
Strong attention to detail and accuracy.
Ability to work on multiple tasks simultaneously in a fast-paced, team-oriented environment while meeting strict deadlines.
Quality-minded approach, including proactively identifying errors and investigating inaccuracies.
Ability to interact effectively with others, manage conflict, and handle stressful situations and deadlines.
Ability to work flexible hours.

Nice To Haves

National Pharmacy Technician Certification (PTCB).
Pharmacy information system experience.

Responsibilities

Research and establish patient eligibility and insurance coverage, and reverify benefit criteria when needed for claim follow-up.
Enter and update patient and insurance information in billing and pharmacy systems.
Maintain and audit patient files and documentation to support third-party audits and payer and company compliance.
Respond to billing inquiries by phone or electronic communication and investigate and resolve billing issues related to eligibility, coverage, and benefits.
Support residents or responsible parties with Medicare plan comparisons during open and special enrollment periods.
Review patient profiles, drug regimens, and insurance coverage to identify options to reduce resident costs.
Complete daily census, admission, discharge, and room-change functions for assigned facilities.
Process patient payments, returns, and credits; transmit individual credit-card payments as needed; and, when applicable, pursue delinquent payments and arrange payment plans.
Research and organize requested audit documentation in a timely manner.
Adjudicate prescription claims, communicate with insurance companies about rejected claims, eligibility, and prior authorizations, and correct and rebill claims as needed.
Develop knowledge of pharmacy facility billing requirements, including Medicare, Medicaid, prescription drug plans, and third-party insurance.
Use pharmacy information systems to process prior authorizations, resolve rejections, produce reports, complete billing functions, and meet operational and regulatory requirements.
Rotate through other departments to gain functional knowledge of their workflows.
Follow applicable government regulations, including HIPAA, and collaborate with the pharmacy team to meet service goals.
Perform other essential functions and duties as assigned.