Pharmacy Billing Specialist
About The Position
The Pharmacy Billing Specialist processes customer bills and insurance claims accurately and on time, assists with daily and month-end billing functions and reporting, and provides customer service to patients, caregivers, medical providers, and insurance carriers. The role supports a long-term care pharmacy serving seniors and individuals with complex care needs. The schedule is Monday through Friday, with varying shifts between 6 a.m. and 7 p.m. The specialist researches insurance eligibility and coverage, maintains accurate patient and insurance records, handles billing inquiries and payment processing, resolves claim and coverage issues, and prepares documentation for audits. The position also supports Medicare plan comparisons, reviews patient profiles and coverage for potential savings, and develops knowledge of facility billing requirements and pharmacy information systems. Work is performed at a desk in an office environment and involves collaboration, customer interaction, and managing deadlines and stressful situations.
Requirements
- High school diploma or GED.
- Pharmacy Technician license, certification, or registration as required by the state; national PTCB certification is preferred and may be required for pharmacy-specific roles.
- At least 1 year of related experience.
- Advanced computer skills.
- Ability to work independently and meet deadlines.
- Strong attention to detail and accuracy.
- Ability to manage multiple tasks simultaneously in a fast-paced, team-oriented environment while meeting strict deadlines.
- Quality-minded approach and motivation to identify errors and investigate 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
- Pharmacy information system experience.
- National Pharmacy Technician Certification Board (PTCB) certification.
Responsibilities
- Research and establish patient eligibility and insurance coverage, and reverify benefits as needed for claims follow-up.
- Enter and update patient and insurance information in billing and pharmacy systems.
- Maintain and audit patient files and documentation to support third-party audits and payer and company compliance.
- Respond to billing inquiries from customers by phone or electronic communication and resolve billing issues involving eligibility, coverage, and benefits.
- Run Medicare plan comparisons during open and special enrollment periods and provide guidance to residents or responsible parties.
- Review patient profiles, drug regimens, and insurance coverage to identify options that may save residents money.
- Complete daily census, admission, discharge, and room-change updates for assigned facilities.
- Process patient payments, returns, and credits; transmit credit card payments as needed; and pursue delinquent payments or arrange payment plans when applicable.
- Research, identify, organize, and provide requested audit documentation in a timely manner.
- Adjudicate prescription claims and communicate with insurance companies about rejected claims, eligibility, prior authorizations, and other issues; make corrections and rebill claims as needed.
- 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.
- Rotate through other departments to learn their workflows.
- Follow applicable government regulations, including HIPAA, and collaborate with the pharmacy team to meet service goals.
- Perform other essential functions and duties as assigned.
Benefits
- Competitive pay
- 401(k) with company match
- Medical, dental, and vision benefits for full-time employees working 30 or more hours per week
- Health Savings Accounts and Flexible Spending Accounts
- Company-paid basic life insurance 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
