Pharmacy Billing Specialist

Guardian Pharmacy • North Port, FL

1d • Onsite

About The Position

Guardian Pharmacy of Southwest Florida, a member of the Guardian family of pharmacies, is seeking a Pharmacy Billing Specialist. This role involves processing customer bills and insurance claims accurately and timely, assisting with daily and month-end billing functions, and providing excellent customer service to patients, caregivers, medical providers, and insurance carriers. The company focuses on delivering customized medication management solutions to healthcare organizations serving seniors and individuals with complex care needs, utilizing tech-enabled pharmacy services. The position is full-time, performed onsite at a closed-door pharmacy in North Port, Florida, and requires comfort working in a high-volume environment. Comprehensive training is provided side by side with a training team. The core focus of Guardian Pharmacy is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs, redefining how pharmacy care is delivered.

Requirements

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification may be required (pharmacy specific).
• 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 be comfortable working in a high-volume environment.
• Must work Saturday.
• Ability to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.

Nice To Haves

• National Certification preferred (PTCB) (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 company match
• Medical, Dental and Vision
• Health Savings Accounts and Flexible Spending Accounts
• Company-paid Basic Life and Accidental Death & Dismemberment
• Company-paid Long-Term Disability and optional Short-Term Disability
• Voluntary Employee and Dependent Life, Accident and Critical Illness
• Dependent Care Flexible Spending Accounts
• Employee Assistance Program (EAP)
• Guardian Angels (Employee assistance fund)
• Paid holidays and sick days
• Generous vacation benefits based on years of service

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED