Billing Specialist - 100% On-Site

Guardian Pharmacy Services Management•Grand Rapids, MI

4d•Onsite

About The Position

Guardian Pharmacy of Michigan is hiring a Billing Specialist in Grand Rapids, Michigan. The role processes customer bills and insurance claims accurately and on time, supports daily and month-end billing functions and reporting, and provides customer service to patients, caregivers, medical providers, and insurance carriers. The position is 100% on-site and is scheduled Monday through Friday, 8:30 a.m. to 5:00 p.m. The stated pay range is $20–$24 per hour, depending on experience. The specialist researches insurance eligibility and coverage, maintains accurate patient and insurance records, responds to billing inquiries, and resolves issues involving coverage, benefits, and rejected claims. The role also supports prescription claims adjudication, prior authorizations, facility billing, patient payments and credits, audit documentation, and enrollment-period Medicare plan comparisons. The employee uses pharmacy information systems to complete billing and related operational tasks, follows applicable regulations including HIPAA, and works collaboratively with other pharmacy departments and team members. The work requires desk work in an office environment. Noise is usually low to moderate, and the employee must interact effectively with others, manage conflict, and handle stressful situations and deadlines. Flexible hours may be 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.
Advanced computer skills.
Ability to work independently and meet deadlines.
Strong attention to detail and accuracy.
Ability to manage multiple tasks in a fast-paced, team-oriented environment while adhering to strict deadlines.
Quality-minded approach, including motivation to identify errors and inquire about inaccuracies.
Ability to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.

Nice To Haves

National pharmacy technician certification, such as PTCB; it may be required for pharmacy-specific needs.
Experience with pharmacy information systems.

Responsibilities

Research and establish patient eligibility and insurance coverage, including with private insurers and government entities.
Reverify benefit coverage criteria as needed for claims follow-up.
Enter and update patient and insurance information accurately in billing and pharmacy systems.
Maintain and audit patient files and documentation to support third-party audits and payer and company compliance.
Respond promptly to billing inquiries from customers by phone or electronic communication.
Research and resolve billing issues related to insurance eligibility, coverage, and benefits.
Support residents or responsible parties by running Medicare plan comparisons during open and special enrollment periods.
Review patient profiles, drug regimens, and insurance coverage to identify potential cost-saving options.
Complete daily census, admissions, discharges, and room changes for assigned facilities.
Process patient payments, returns, and credits; transmit individual credit-card payments as needed.
Pursue payment on delinquent accounts and arrange payment plans when applicable.
Research, identify, and organize requested audit documentation within required timelines.
Adjudicate prescription claims and communicate with insurers about rejected claims, eligibility, prior authorizations, and other issues.
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 for prior authorizations, rejection resolution, reporting, billing, and regulatory requirements.
Rotate through other departments to gain functional knowledge of their workflows.
Follow applicable government regulations, including HIPAA.
Collaborate with pharmacy team members to meet service goals.
Perform other essential duties as assigned.

Benefits

Competitive pay.
401(k) with company match.
Medical, dental, and vision benefits 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 & 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.