Billing Specialist

Guardian Pharmacy; Eden Prairie (MN); On-site; USD 30,000 - 36,000; Full time

Benefits offered by this job

401(k) match

Medical Insurance

Dental Insurance

Vision Insurance

HSA/FSA

Long-term Disability

Life Insurance

Job summary

Guardian Pharmacy of Minnesota in Eden Prairie, MN is seeking a detail-oriented Billing Specialist to join our fast-paced team. You will process patient billing and insurance claims, assist with daily and month-end billing, and deliver excellent service to patients, caregivers, providers, and carriers.

As part of a collaborative, HIPAA-compliant environment, you will maintain patient files, handle inquiries, and support open enrollment and payment processes while adhering to regulatory

Qualifications

• 1+ year of related experience in billing or pharmacy setting.
• Advanced computer skills; pharmacy software experience preferred.
• Ability to work independently and deliver to deadlines.

Responsibilities

• Process patient billing and insurance claims timely and accurately.
• Enter and update patient/insurance information in billing system.
• Research and resolve billing inquiries via phone or email.
• Provide guidance during open enrollment; review patient coverage to save money.
• Maintain patient files for audits and ensure payer compliance.

Skills

Pharmacy software experience

Attention to detail

Independent worker

Deadline-driven

Fast-paced environment

Education

High School Diploma or GED

Pharmacy Technician license/certification

National Certification preferred (PTCB)

Tools

Pharmacy information system

Job description

Eden Prairie, Minnesota, United States of America

Extraordinary Care. Extraordinary Careers.

With one of the nation’s largest, most innovative long-term care pharmacy services providers, there is no limit to the growth of your career.

Guardian Pharmacy of Minnesota, a member of the Guardian family of pharmacies, has an exciting opportunity for you to join our rapidly growing team in Eden Prairie, Minnesota.

Why Guardian Pharmacy of Minnesota? We’re reimagining medication management and transforming care.

Who We Are And What We’re About

Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. With our comprehensive suite of tech-enabled pharmacy services and a dedicated team of professionals committed to enriching the lives of those we serve, we are redefining how pharmacy care is delivered.

We offer an opportunity to learn and grow your career in a fast-paced, diverse, and inclusive environment. If you are looking for a challenging, team-oriented environment in which you can put your expertise to work, then this is the place for you.

Starting Pay Range: $22-$26

Scheduling Requirements: Department hours 8am-7pm, with the expectation of an opening shift and a closing shift per week. Weekends are once every 4 weeks, on call.

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.

Required

ATTRIBUTES REQUIRED:

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Relational – ability to build relationships with business unit management and become “trusted advisor.”
• Strategy and Planning – ability to think ahead, plan and manage time efficiently.
• Problem Solving – ability to analyze causes and solve problems at functional level.
• Team Oriented – ability to work effectively and collaboratively with all team members.

ESSENTIAL JOB FUNCTIONS (include The Following)

• 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. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions.
• 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.
• Other essential functions and duties may be assigned as needed.

Education And/Or Certifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).

Skills And Qualifications

• 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 inquiry about inaccuracies.

WORK ENVIRONMENT:

• 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.

What We Offer

Guardian provides employees with a comprehensive Total Rewards package, supporting our core value of, “Treat others as you would like to be treated.” Compensation & Financial

• Competitive pay
• 401(k) with company match

• Medical, Dental and Vision
• Health Savings Accounts and Flexible Spending Accounts
• Company-paid Basic Life and Accidental Death & Dismemberment
• Company-paid Long-Term Disability and optional Short-Term Disability