Pharmacy Billing Specialist

Staffingly, Inc; Bogotá; On-site; COP 44,640,000 - 78,120,000; Full time

Job summary

Staffingly, Inc. is seeking an experienced Pharmacy Billing Specialist to support U.S. pharmacy operations serving long-term care and other healthcare facilities. This on-site role in Colombia requires hands-on prescription-billing experience and strong communication with pharmacy staff, facilities, PBMs and payers.

You will process claims, verify data, resolve rejections, and ensure accurate, compliant billing while coordinating with facility teams and maintaining HIPAA privacy standards.

Qualifications

• 3-5+ years hands-on prescription-billing experience with U.S. pharmacy claims.
• Experience with facility or hospital billing and communicating with pharmacy, payer or facility teams about billing issues.
• Knowledge of days' supply calculations, SIG codes and accurate prescription-data entry.

Responsibilities

• Process prescription claims and verify patient, prescriber, prescription and insurance information before submitting claims.
• Check coverage: confirm pharmacy benefits, eligibility and payer details; identify missing or conflicting information and flag coverage issues promptly.
• Resolve insurance rejections: investigate issues and reprocess within approved procedures.
• Coordinate payer follow-up: contact insurance plans and PBM help desks, document reference numbers and required actions.
• Calculate days' supply and enter data using SIG codes and approved directions.
• Support facility billing: research hospital or facility billing questions, reconcile account discrepancies and route charges to the correct account.
• Manage outstanding work: track rejected, unpaid or reversed claims, follow-up dates and escalation owners.
• Communicate clearly: handle billing calls professionally and provide accurate updates.
• Maintain privacy: follow HIPAA procedures and keep complete account notes.

Skills

Prescription billing

English communication

Attention to detail

Independent work

Job description

U.S. Pharmacy Operations | Long-Term Care

Location: Colombia, ON SITE ONLY. NO REMOTE. City to be shared during screening

Work arrangement: ON SITE ONLY. NO REMOTE WORK. Candidates must live in or be able to relocate to the on-site city at their own cost before starting.

Schedule: Assigned U.S. hours; exact shift confirmed during screening

Staffingly, Inc. is seeking an experienced Pharmacy Billing Specialist to support U.S. pharmacy operations serving long-term care and other healthcare facilities. You will help process prescription claims accurately, resolve insurance rejections, follow up on billing issues and keep pharmacy and facility teams informed.

This role requires hands-on prescription-billing experience. Strong communication and careful follow-through are essential when working with pharmacy staff, facilities, insurance plans and pharmacy benefit managers (PBMs).

What you will do

• Process prescription claims: bill regular and specialty medications; verify patient, prescriber, prescription and insurance information before submitting claims through approved systems.
• Check coverage: confirm pharmacy benefits, eligibility and payer details; identify missing or conflicting information and flag coverage issues promptly.
• Resolve insurance rejections: investigate issues such as incorrect member details, refill-too-soon messages, quantity limits, coverage restrictions and prior-authorization requirements, then correct and reprocess within approved procedures.
• Coordinate payer follow-up: contact insurance plans and PBM help desks, document reference numbers and required actions, and coordinate missing information with pharmacy or facility staff.
• Calculate days' supply and enter data: use approved prescription directions and SIG codes to calculate days' supply and enter authorized prescription-label information.
• Support facility billing: research hospital or facility billing questions, reconcile account discrepancies and help route charges to the appropriate account.
• Manage outstanding work: track rejected, unpaid or reversed claims, follow-up dates and escalation owners.
• Communicate clearly: handle billing calls and messages professionally, explain administrative next steps and provide accurate updates without promising coverage or payment.
• Maintain quality and privacy: keep complete account notes, meet agreed accuracy and turnaround standards, and follow HIPAA-related privacy, security and approved-access procedures.

ON SITE REQUIREMENTS (NO REMOTE)

This role is ON SITE ONLY in Colombia. NO REMOTE WORK. Applicants must be based in Colombia, able to work from the office every working day, and available for the assigned U.S. schedule. Compliance with company device and secure-access requirements is required. Exact shift, compensation and engagement terms will be discussed during recruitment.

Required qualifications

• 3-5+ years of hands-on prescription-billing experience, including U.S. pharmacy insurance claims, rejection resolution and claim correction or resubmission.
• Experience with facility or hospital billing and communicating with pharmacy, payer or facility teams about billing issues.
• Practical knowledge of days' supply calculations, SIG codes and accurate prescription-data entry under approved pharmacy procedures.
• Strong spoken and written English for U.S. pharmacy, payer and facility communication; excellent telephone and customer-service skills.
• Strong attention to detail, organization and prioritization; ability to work independently within an on-site team.

Preferred experience

• Retail and/or specialty pharmacy billing; long-term care pharmacy or skilled nursing facility workflows.
• Familiarity with Medicare Part D, Medicaid and commercial pharmacy/PBM billing, coordination of benefits and facility-versus-payer billing workflows.
• Administrative prior-authorization follow-up, billing reconciliation and outstanding-claim worklists.
• English-Spanish bilingual communication is an advantage.