Billing Specialist I — LTC Pharmacy Adjudication

Guardian Pharmacy, LLC

Winston-Salem (NC)

On-site

USD 40,000 - 48,000

Full time

14 days+

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Benefits offered by this job

401(k) with company match

Medical, Dental, Vision benefits

Paid holidays and vacation

Job summary

Guardian Pharmacy Services in Kernersville, North Carolina, is seeking a Pharmacy Billing Specialist to process customer bills and insurance claims with accuracy and timely execution. The role emphasizes exceptional customer service to patients, caregivers, providers, and insurance carriers, with a Monday–Friday schedule and optional Saturday rotation.

Responsibilities include eligibility research, claims adjudication, and maintaining patient records while ensuring compliance with all regulatory

Qualifications

1+ years of related experience in billing or pharmacy billing.
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 while meeting deadlines.

Responsibilities

Research and establish patient eligibility coverage with insurance providers.
Reverify benefit coverage criteria for claims follow up.
Enter patient/insurance information into billing system accurately.
Maintain and audit patient files for third-party audits and compliance.
Enter patient information into the pharmacy system and respond to billing inquiries.
Research and resolve patient billing issues related to eligibility and coverage.
Run Medicare plan comparisons during enrollment periods and assist residents/parties as needed.
Process daily census, admissions, discharges, and room changes for facilities.
Process payments, returns, and credits; transmit card payments as needed.