Pharmacy Billing Specialist

Elderwood • Buffalo, NY

3d • Onsite

About The Position

Woodmark Pharmacy of NY is seeking an experienced, detail-oriented Pharmacy Billing Specialist to support residents and their families. This is a full-time, on-site position, and candidates are expected to already reside in the area because interviews are conducted in person. The schedule is days, 8:00 a.m. to 4:00 p.m. Starting pay is $18.00 per hour, with base wages increasing based on experience.

The role handles pharmacy claim billing for Medicare, Medicaid, third-party insurance, skilled nursing facilities, assisted living facilities, and private-pay customers. The specialist reviews billing and invoices, investigates rejected claims, supports prior authorizations and Medicaid rebilling, and maintains census and payer-status information. The position requires regular interaction with residents, coworkers, visitors, and supervisors, as well as intermediate-or-higher English reading, writing, speaking, and comprehension skills to support communication and a safe work environment.

Requirements

• Associate degree, or high school diploma or GED, and 1–2 years of medical billing or collections experience; long-term care experience is preferred. Pharmacy Technician experience in retail, long-term care, or a hospital is also listed as an alternative experience background.
• Excellent customer service and phone skills.
• Microsoft Office 365 skills.
• Excellent organizational and time-management skills.
• Self-motivated, with the ability to solve problems effectively.
• Intermediate-or-higher English reading, writing, speaking, and comprehension skills.
• Candidates are expected to already reside in the area; the interview process is in person.

Nice To Haves

• Long-term care medical billing or collections experience.
• Experience with pharmacy claims and different types of pharmacy billing.
• Sage 300 and Framework LTC software experience.

Responsibilities

• Electronically bill Medicare, Medicaid, and third-party insurance pharmacy claims using the Framework LTC Pharmacy system.
• Bill skilled nursing facility, assisted living facility, and private-pay pharmacy claims.
• Troubleshoot rejected insurance claims to secure payment.
• Obtain prior authorizations required by third-party insurance.
• Review bills and invoices.
• Review Medicaid-pending status and rebill Medicaid claims as needed.
• Maintain updated skilled nursing facility census and resident payer-status information.
• Complete projects as needed.
• Provide customer service to external and internal customers.

Benefits

• Full benefits package including medical, dental, vision, and life insurance.
• 401(k) with company match.
• Competitive pay; base wages increase with experience.
• Weekly paycheck.
• Solid team atmosphere.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree