Pharmacy Billing & Claims Specialist

Guardian Pharmacy

Ammon (ID)

On-site

USD 36,000 - 60,000

Full time

14 days+

Application generator

Don’t send a generic resume — generate a resume and cover letter tailored to this exact role.

Get past ATS filters

Benefits offered by this job

401(k) with company match

Medical, Dental and Vision

Health Savings Accounts

Flexible Spending Accounts

Long-Term Disability

Short-Term Disability

Life Insurance

Time Off: holidays & vacation

Job summary

Guardian Pharmacy Idaho Falls (Heartland Pharmacy) is seeking a Billing Specialist to join our rapidly growing team. You will process customer bills and insurance claims, verify patient eligibility, and support open enrollment with carriers.

The role emphasizes accuracy, HIPAA compliance, and dedicated customer service to patients, caregivers, and providers. Ideal candidates have a high school diploma or GED, pharmacy technician credentials per state, and 1+ years of related experience.

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 handling multiple tasks with deadlines.
Quality minded; motivated to seek out errors and inquire about inaccuracies.

Responsibilities

Research and establish patient eligibility coverage with insurance providers; reverify coverage as needed for claims follow up.
Enter patient information into billing system and maintain patient files for audits.
Respond to billing inquiries via phone or electronic communications; resolve insurance eligibility issues.
Run Medicare plan comparisons and review patient profiles to optimize coverage and costs.
Process daily census, admissions, discharges, and room changes for facilities assigned.
Process payments, returns, credits, and transmit credit card payments as needed.
Assist with delinquent accounts and payment arrangements as required.
Perform claims adjudication and communicate with insurers on rejections or authorizations.
Develop knowledge of Medicare, Medicaid, PDPs and third-party insurance billing requirements.
Use pharmacy information systems to process prior authorizations, resolve rejections, and generate reports.