Billing Specialist I: Pharmacy Claims & Insurance

Guardian Pharmacy, LLC; North Carolina; On-site; USD 38,000 - 54,000; Full time

Benefits offered by this job

401(k) with company match

Medical, Dental and Vision

Health Savings Accounts

Time Off - paid holidays and sick days

Job summary

Guardian Pharmacy, LLC in Pink Hill, North Carolina seeks a Pharmacy Billing Specialist to process patient bills and insurance claims with accuracy and timeliness. You will handle daily billing tasks, assist with month‑end procedures, and provide excellent support to patients, caregivers, providers and insurers.

The role emphasizes eligibility verification, claims follow‑up, data entry, audits for payer compliance, and collaboration across departments while adhering to HIPAA in a fast‑paced team

Qualifications

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

Responsibilities

• 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.

Skills

Attention to detail

Independent work

Billing knowledge

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration (state requirements)

Tools

Pharmacy information systems

Job description

Guardian Pharmacy, LLC in Pink Hill, North Carolina seeks a Pharmacy Billing Specialist to process patient bills and insurance claims with accuracy and timeliness. You will handle daily billing tasks, assist with month‑end procedures, and provide excellent support to patients, caregivers, providers and insurers.

The role emphasizes eligibility verification, claims follow‑up, data entry, audits for payer compliance, and collaboration across departments while adhering to HIPAA in a fast‑paced team