Pharmacy Billing Specialist - 100% On-Site
Guardian Pharmacy
Summary
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.
Job description
Essential Job Functions
- 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.
- 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.
Requirements
- High School Diploma or GED required
- Pharmacy Technician license/certification/registration per state requirements
- National Certification preferred (PTCB) may be required (pharmacy specific)
- 1+ years of related experience
- Advanced computer skills; pharmacy information system experience preferred
- 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
Benefits
- 401(k) Matching
- Medical, Dental & Vision
- Wellness Incentive Program
- Life Insurance
- AD&D Insurance
- Long-Term Disability
- Short-Term Disability
- Accident Insurance
- Critical Illness Insurance
- Dependent Care FSA
- Employee Assistance Program
- Paid Holidays
- Sick Days
- Paid Vacation
Company overview
Guardian Pharmacy is a pharmaceutical company specializing in the manufacturing and distribution of pharmaceutical products. As a pharmaceutical manufacturer, Guardian Pharmacy focuses on developing, producing, and supplying medications to healthcare providers, pharmacies, and patients. The company operates within the pharmaceutical manufacturing sector, which involves the production of prescription drugs, over-the-counter medications, and potentially specialized pharmaceutical formulations. Pharmaceutical manufacturing companies like Guardian Pharmacy play a critical role in the healthcare ecosystem by ensuring the availability of essential medications, maintaining quality control standards, and adhering to regulatory requirements set by health authorities. These companies typically engage in various aspects of the pharmaceutical value chain, including research and development, formulation development, manufacturing processes, quality assurance, packaging, and distribution. Guardian Pharmacy's operations likely involve producing both generic and branded pharmaceutical products, serving healthcare markets with essential medicines that address various medical conditions and therapeutic needs.