Billing Specialist

Reliance Rx Specialty Pharmacy; Buffalo (NY); Hybrid; USD 31,000 - 32,000; Full time

Benefits offered by this job

Hybrid position

Onsite in Williamsville

Job summary

Reliance Rx Specialty Pharmacy is seeking a Billing Specialist to handle pharmacy and medical claim billing, resolve rejections, and coordinate with patients, insurance companies, doctors, and staff. The role supports CMS guidelines and ensures timely delivery milestones.

This hybrid position requires onsite work at our Williamsville location and offers a comprehensive benefits package along with an incentive program. Immigration sponsorship is not provided.

Qualifications

• High school diploma or GED required.
• National Pharmacy Technician Certification (CPhT) preferred.
• One year of experience in a high-volume pharmacy or six months in Reliance Rx Operations & Compliance.
• Experience with online claims processing system preferred.
• Strong oral and written communication skills; ability to work with health care professionals.

Responsibilities

• Billing of all pharmacy and medical claims; manage rejections and ensure follow-up.
• Act as liaison between patients, insurers, doctors, medical staff and admin staff.
• Work with payors to resolve billing issues.
• Ensure compliance with CMS guidelines for Medicare and Medicaid.
• Confirm billing accuracy and payor requirements.
• Process and set up deliveries to medical offices and manage medical claims.

Skills

Billing

Claims processing

Medical billing

Communication skills

Physical endurance

Education

High school diploma or GED

CPhT preferred

Tools

Online claims processing system

Job description

FIND YOUR FUTURE

We’re excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Billing Specialist assists with the various activities of the pharmacy operations not requiring the professional judgment of the pharmacist. The Billing Specialist is primarily responsible for completing the billing of both pharmacy and medical claims and adjudicating rejections.

Qualifications

• High school diploma or GED required. National Pharmacy Technician Certification (CPhT) preferred.
• One (1) year of experience working in a high-volume pharmacy, or equivalent setting, required, or six (6) months as a temporary associate in the Reliance Rx Operations & Compliance department.
• Experience working with online claims processing system preferred.
• Effective oral and written communication skills and an aptitude for working with other health care professionals.
• Ability to lift a minimum of 5 lbs.
• Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.

Essential Accountabilities

• Responsible for billing all claims (pharmacy and medical) and managing rejections to ensure appropriate follow up and delivery promise times are met.

• Act as a liaison between patients and insurance companies, and facilitate communication between patients and doctors, medical staff and administrative staff.

• Work with payors to resolve any billing issues.

• Ensure Reliance Rx is following CMS guidelines per Medicare and Medicaid guidance

• Confirmation of billing accuracy and payor billing/shipping requirements.

• Process and set up deliveries to medical offices.

• Medical claims billing for both supplies and medications.

• Confirm financial aspects of the claims prior to them leaving the facility.

• Portal management including refill reminders, processing orders from the portal, and completing patient registrations.

• Financial assistance coordination with patients for foundation care, copay assistance, or free medication programs where applicable.

• Assist the Patient Care Specialists in workflow and with incoming and outgoing calls in accordance with business needs, to include but not limited to:

• maintaining patient records; filing and documentation duties.

• set up and data entry.

• financial arrangements and collecting co-payments.

• prior authorization assistance with offices.

• coordination of benefits.

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• promote information sharing and continuous process improvement.

• Function in strict accordance with standard, written procedures and guidelines with deviation approved by the supervising pharmacist.

This is a hybrid position with onsite attendance required at our Williamsville location.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $22.50 - $23.50 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / affirmatively action employer Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub.