LTC Pharmacy Billing & Adjudication Specialist

Guardian Pharmacy; Kernersville (NC); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Competitive pay

401(k) with company match

Medical, Dental and Vision insurance

Health Savings Accounts and Flexible‑S

Company‑paid life and disability

EAP and paid holidays

Job summary

Kernersville, North Carolina-based Guardian Pharmacy seeks a Billing Adjudication specialist to process patient eligibility, insurance claims, and daily billing for long‑term care facilities. You will enter data accurately, support audits, and assist with open enrollment and patient inquiries.

The role emphasizes attention to detail, teamwork, and adherence to HIPAA in a fast-paced healthcare billing environment. Weekend rotation may be required.

Qualifications

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

Responsibilities

• Process patient eligibility with insurance providers and enter data into billing system.
• Maintain and audit patient files for third‑party audits and compliance; enter patient information into the pharmacy system.
• Provide timely responses to billing inquiries via phone or electronic communications; resolve issues.
• Run Medicare plan comparisons during enrollment periods to save residents money.
• Complete daily census, admit, discharge, and room changes for facilities.
• Process patient payments, returns, and credits; transmit card payments as needed.
• Perform prescription claims adjudication and rebill as necessary; address rejections with insurers.
• Follow HIPAA and work as part of a collaborative team to meet service goals.

Skills

Experience

Technical skills

Independence

Attention to detail

Multitasking

Quality mindset

Education

High School Diploma

Pharmacy Technician license

Tools

Pharmacy information system

Job description

Kernersville, North Carolina-based Guardian Pharmacy seeks a Billing Adjudication specialist to process patient eligibility, insurance claims, and daily billing for long‑term care facilities. You will enter data accurately, support audits, and assist with open enrollment and patient inquiries.

The role emphasizes attention to detail, teamwork, and adherence to HIPAA in a fast-paced healthcare billing environment. Weekend rotation may be required.