Pharmacy Billing Specialist

Guardian Pharmacy•Cincinnati, OH

2d•Onsite

About The Position

Mullaney’s Pharmacy & Home Healthcare, a member of the Guardian family of pharmacies, is one of the nation’s largest and most innovative long-term care pharmacy services providers. They are actively reimagining medication management and transforming care, with a core focus on delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. The company offers a comprehensive suite of tech-enabled pharmacy services and a dedicated team committed to enriching the lives of those they serve, redefining how pharmacy care is delivered. This role presents an opportunity to learn and grow a career in a fast-paced, diverse, and inclusive environment, seeking individuals who thrive in a challenging, team-oriented setting where they can apply their expertise.

Requirements

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.
Must possess intrinsic drive to excel coupled with values in line with company philosophy (Work Ethic/Integrity).
Ability to build relationships with business unit management and become “trusted advisor” (Relational).
Ability to think ahead, plan and manage time efficiently (Strategy and Planning).
Ability to analyze causes and solve problems at functional level (Problem Solving).
Ability to work effectively and collaboratively with all team members (Team Oriented).

Nice To Haves

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

Responsibilities

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.

Benefits

Competitive pay
401(k) with up to 3.5% company match
Multiple health plan options including copay (FSA-eligible) and HSA eligible plans
Wellness Incentive Program
Dental and Vision plans
Company-paid basic life, AD&D and long-term disability coverage
Optional employee, spouse, and child life/AD&D insurance
Optional accident, critical illness, and short-term disability coverage
Dependent Care Flexible Spending Accounts
Employee Assistance Program (EAP)
Paid holidays and sick days
Generous vacation benefits based on years of service