Billing Specialist I

Guardian Pharmacy•Pink Hill, NC

4d•Onsite

About The Position

Southern Pharmacy Services, a member of the Guardian family of pharmacies, is hiring a Billing Specialist I in Pink Hill, North Carolina. The role processes customer bills and insurance claims accurately and promptly, supports daily and month-end billing functions and reporting, and provides customer service to patients, caregivers, medical providers, and insurance carriers. The position works in an office environment and requires desk work, collaboration, and the ability to manage stressful situations and deadlines. Flexible hours are required.

Requirements

High school diploma or GED.
At least 1 year of related experience.
Pharmacy Technician license, certification, or registration as required by state requirements; national PTCB certification 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 motivation to identify errors and ask about inaccuracies.
Ability to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.
Ability to work flexible hours.

Nice To Haves

National Pharmacy Technician Certification Board (PTCB) certification is preferred.
Experience with a pharmacy information system is preferred.

Responsibilities

Research and establish patient eligibility and insurance coverage, reverify benefits as needed, and enter or update patient and insurance information in billing and pharmacy systems.
Maintain and audit patient files and supporting documentation to meet payer and company compliance requirements and respond to third-party audits.
Respond promptly to billing inquiries by phone or electronic communication and research and resolve issues involving eligibility, coverage, and benefits.
Run Medicare plan comparisons during open and special enrollment periods and review patient profiles, drug regimens, and insurance coverage to identify potential savings.
Complete daily census, admissions, discharges, and room changes for assigned facilities.
Process patient payments, returns, and credits, including transmitting individual credit card payments as needed.
May pursue payment on delinquent accounts and make payment arrangements.
Research and organize requested audit documentation in a timely manner.
Adjudicate prescription claims, communicate with insurance companies about rejected claims, eligibility, prior authorizations, and other issues, and correct and rebill claims as necessary.
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, and complete billing functions in support of operational and regulatory requirements.
Rotate through other departments to learn their workflows.
Follow applicable government regulations, including HIPAA.
Collaborate with team members to meet pharmacy service goals.
Perform other essential functions and duties as assigned.

Benefits

Competitive pay
401(k) with company match
Medical, dental, and vision coverage for eligible full-time employees working 30 or more hours per week
Health Savings Accounts and Flexible Spending Accounts
Company-paid basic life and accidental death and dismemberment insurance
Company-paid long-term disability and optional short-term disability
Voluntary employee and dependent life, accident, and critical illness coverage
Dependent Care Flexible Spending Accounts
Employee Assistance Program
Guardian Angels employee assistance fund
Paid holidays and sick days
Vacation benefits based on years of service