Pharmacy Billing Specialist

Guardian Pharmacy•Cedar Rapids, IA

1d•Onsite

About The Position

Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month-end billing functions, procedures and reporting. Provides excellent customer service to patients, caregivers, medical providers and insurance carriers. Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities. Reverify benefit coverage criteria as needed for claims follow up. Accurately enters and/or updates patient/insurance information into billing system. Maintain and continually audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance. Accurately enter patient information into the pharmacy system. Provide assistance and timely response to all billing customer inquiries via phone or electronic communications. Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits. Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods. Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money. Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned. Process patient payments, returns, and credits. Transmit individual credit card payments as needed. May pursue payment from delinquent accounts and make payment arrangements. Research, identify and organize requested audit documentation in timely manner. Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed. Make corrections as needed and rebill claims as necessary. Develop knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions. Rotate through other departments to gain working/functional knowledge of other department workflows. Follow all applicable government regulations including HIPAA. Work as a collaborative team member to meet the service goals of the pharmacy. Other essential functions and duties may be assigned as needed.

Requirements

MUST HAVE NATIONAL CERTRIFICATION PTCB OR NHA
High School Diploma or GED required.
Pharmacy Technician license/certification/registration per state requirements.
1+ years of related experience.
Advanced computer skills.
Ability to work independently and deliver to deadlines.
Great attention to detail and accuracy.
Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines.
Quality minded; motivated to seek out errors and inquire about inaccuracies.

Nice To Haves

National Certification preferred (PTCB) may be required (pharmacy specific).
Pharmacy information system experience preferred.

Responsibilities

Processing customer bills and insurance claims accurately and timely.
Assisting with daily and month-end billing functions, procedures, and reporting.
Providing excellent customer service to patients, caregivers, medical providers, and insurance carriers.
Researching and establishing patient eligibility coverage with insurance providers.
Reverifying benefit coverage criteria for claims follow-up.
Accurately entering and/or updating patient/insurance information into the billing system.
Maintaining and auditing patient files and documentation for third-party audits and compliance.
Entering patient information into the pharmacy system.
Responding to billing customer inquiries via phone or electronic communications.
Researching and resolving patient billing issues related to insurance eligibility, coverage, and benefits.
Providing guidance on Medicare plan comparisons during open enrollment and special enrollment periods.
Reviewing patient profiles, drug regimens, and insurance coverage to identify cost-saving options for residents.
Completing daily census, admit, discharge, and room changes for assigned facilities.
Processing patient payments, returns, and credits.
Transmitting individual credit card payments.
Pursuing payment from delinquent accounts and making payment arrangements.
Researching, identifying, and organizing requested audit documentation.
Performing prescription claims adjudication, including communication with insurance companies regarding rejections, eligibility, prior authorizations, or other issues.
Making corrections and rebilling claims as necessary.
Developing knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, Third-Party Insurances).
Developing proficiency in pharmacy information systems for operational needs and regulatory requirements.
Rotating through other departments to gain functional knowledge.
Following all applicable government regulations, including HIPAA.
Working collaboratively with team members to meet pharmacy service goals.