Sr. Billing Specialist

Guardian Pharmacy Services Management•Phoenix, AZ

8d•Onsite

About The Position

Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month-end billing functions, procedures and reporting. Provides excellent customer service to patients, caregivers, medical providers and insurance carriers. The work environment characteristics described here are representative of those an employee encounters while performing the job. The noise level in the work environment is usually low to moderate. Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. Requires desk work in office environment. Ability to work flexible hours.

Requirements

High School Diploma or GED required.
Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).
2 + years related experience including a minimum of 6 months billing experience in long term care or retail setting.
Advanced computer skills; pharmacy information system experience required
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.

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.
Uses working knowledge to troubleshoot and resolve customer service issues.
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.
Through prior experience and cross training, demonstrate knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions
Exercise 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 in a timely manner and with a high degree of accuracy.
Consistently meet pharmacy's established accuracy and productivity levels.
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