Billing Specialist

ih; United States; Hybrid; USD 31,000 - 32,000; Full time

Benefits offered by this job

scorecard incentive

full range of benefits

generous paid time off

Job summary

Independent Health is hiring a Billing Specialist to support pharmacy operations by handling billing for pharmacy and medical claims and resolving rejections. The role requires accuracy and collaboration with patients, doctors, and insurers, with a focus on CMS guidelines.

The position is hybrid with onsite attendance at our Williamsville location. Candidates should have a high school diploma or GED and pharmacy tech certification is preferred; experience in high-volume settings is expected.

Qualifications

• Requires HS diploma or GED.
• CPhT certification preferred.
• 1 year in a high-volume pharmacy or 6 months in Reliance Rx Ops.
• Experience with online claims processing systems preferred.
• Strong oral and written communication with healthcare professionals.
• Able to lift at least 5 lbs.
• Demonstrates Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.

Responsibilities

• Bill all pharmacy and medical claims and manage rejections.
• Liaise between patients, insurance companies, doctors and staff.
• Resolve billing issues with payors.
• Follow CMS guidelines for Medicare/Medicaid.
• Confirm billing accuracy and payor requirements.
• Process deliveries to medical offices.
• Billing for medical supplies and medications.
• Verify financial aspects before claims leave the facility.
• Portal management: reminders, orders, patient registrations.
• Coordinate financial assistance and co-pay programs.
• Support Patient Care Specialists with calls and records, data entry and arrangements.
• Operate per standard procedures with pharmacist approval.

Skills

Oral communication

Written communication

Team collaboration

Customer service

Education

High school diploma or GED

National Pharmacy Technician Certification (CPhT)

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.
  • 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

Hiring Compensation Range: $22.50 - $23.50 hourly

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

Benefits

• scorecard incentive
• full range of benefits
• generous paid time off

The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Aff… 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.

Current Associates must apply internally via the Job Hub.