Pharmacy Billing & Claims Expert

Guardian Pharmacy; Englewood (CO); On-site; USD 68,770,000 - 80,231,000; Full time

Benefits offered by this job

Medical, Dental and Vision

Job summary

Guardian Pharmacy of Englewood seeks a Billing Specialist III to join our team in Englewood, CO. You will research insurance eligibility, process claims, and maintain patient billing records with accuracy and care.

You will respond to billing inquiries, verify coverage, and support Medicare/Medicaid and third-party plans. This role requires adherence to HIPAA and a strong eye for detail in a fast-paced environment.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).
• 3+ years related experience including a minimum of 1 year at Billing Specialist II level.
• Advanced computer skills; pharmacy information system experience required

Responsibilities

• Research and establish patient eligibility coverage with insurance providers.
• Maintain and audit patient files and documentation for audits and compliance.
• Provide timely response to billing inquiries via phone or electronic communications.
• Run Medicare plan comparisons during enrollment periods and review patient profiles for cost-saving options.
• Manage daily census, admissions, discharges, and room changes for facilities.
• Process patient payments, returns, and credits; transmit credit card payments.

Skills

Works Ethic/Integrity

Relational

Strategy and Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration

National Certification (PTCB)

Tools

Pharmacy information systems

Advanced computer skills

Job description

Guardian Pharmacy of Englewood seeks a Billing Specialist III to join our team in Englewood, CO. You will research insurance eligibility, process claims, and maintain patient billing records with accuracy and care.

You will respond to billing inquiries, verify coverage, and support Medicare/Medicaid and third-party plans. This role requires adherence to HIPAA and a strong eye for detail in a fast-paced environment.