Pharmacy Technician - Billing Specialist

Guardian Pharmacy Services Management•Tulsa, OK

9d•Onsite

About The Position

Boomer Solutions of Tulsa, a member of the Guardian family of pharmacies, is seeking a Pharmacy Technician - Billing Specialist. This role is responsible for processing customer bills and insurance claims accurately and efficiently, including daily and month-end billing functions, procedures, and reporting. The position also involves providing excellent customer service to patients, caregivers, medical providers, and insurance carriers. The company is committed to reimagining medication management and transforming care for healthcare organizations serving seniors and individuals with complex needs, offering a fast-paced, diverse, and inclusive environment for career growth.

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.

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 government entities.
Reverify benefit coverage criteria as needed for claims follow-up.
Accurately enter and/or update patient/insurance information into the billing system.
Maintain and continually audit patient files and corresponding documentation 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 residents or responsible parties 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 residents money.
Responsible for completion of daily census, admit, discharge, and room changes for assigned facilities.
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 a 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 of 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, including processing prior authorizations, resolving rejections, producing reports, and completing 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.