Billing Specialist

Independent Health Association; Buffalo (NY); Hybrid; USD 29,000 - 32,000; Full time

Job summary

Reliance Rx in Williamsville is hiring a Billing Specialist to handle pharmacy and medical claims, manage rejections, and serve as a liaison between patients, insurers and clinicians. The role requires accuracy in billing, knowledge of payor requirements and effective collaboration with care teams.

The position is hybrid with onsite attendance in Williamsville. Compensation range is $21.50–$22.50 per hour, with benefits and incentive opportunities.

Qualifications

• High school diploma or GED required; 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.
• Excellent oral and written communication, ability to work with health care professionals.
• Must be able to lift a minimum of 5 lbs.
• Demonstrated alignment with Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.

Responsibilities

• Billing all pharmacy and medical claims and managing rejections to meet follow-up and delivery promises.
• Serve as liaison between patients and insurance companies, and coordinate with doctors and staff.
• Resolve billing issues with payors.
• Ensure CMS, Medicare and Medicaid guidelines are followed.
• Confirm billing accuracy and payor requirements before claims leave the facility.
• Process and set up deliveries to medical offices and handle medical claims for supplies and medications.
• Coordinate finances of claims and manage portal tasks including registrations and refill reminders.
• Assist with patient financial counseling and copay programs where applicable.
• Support Patient Care Specialists with calls and workflow, including maintaining records and data entry.
• Operate under written procedures and obtain approval for deviations from supervising pharmacist.

Skills

Communication skills

Claims processing experience

Billing

CMS guidelines knowledge

Lifting ability

Education

High school diploma or GED

National Pharmacy Technician Certification (CPhT)

Job description

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.
• 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: $21.50 - $22.50 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 / Aff. affirm. ... (one line) ... law. for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub.