Pharmacy Billing & Claims Specialist

Guardian Pharmacy; Englewood (CO); On-site; USD 30,000 - 36,000; Full time

Benefits offered by this job

401(k) with company match

Medical, Dental & Vision

Paid holidays & vacation

Job summary

Guardian Pharmacy Englewood is seeking a Pharmacy Billing Specialist to manage patient eligibility and insurance claims with accuracy. You will handle daily billing tasks, verify coverages, and respond to inquiries while ensuring compliance with HIPAA and regulatory standards.

The role requires a high school diploma and a Pharmacy Technician license, with 1+ years of experience preferred. On-site work in Englewood, CO, with competitive pay and benefits.

Qualifications

• Pharmacy technician license/certification 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.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers; enter patient information into billing system.
• Maintain and audit patient files to defend third party audits and ensure payer compliance.
• Respond to patient billing inquiries via phone or electronic communications; resolve billing issues.
• Run Medicare plan comparisons during enrollment periods and evaluate options to save residents money.
• Process daily census, admissions, discharges, and room changes for facilities.
• Process payments, returns, and credits; transmit credit card payments as needed.
• Perform prescription claims adjudication and resolve rejections with insurers.
• Develop knowledge of Medicare/Medicaid and PDPs billing requirements.
• Utilize pharmacy information systems for prior authorizations and reporting.

Skills

Attention to detail

Independent worker

Team player

Computer proficiency

Education

High School Diploma or GED

Pharmacy Technician license/certification

Tools

Pharmacy information system

Job description

Guardian Pharmacy Englewood is seeking a Pharmacy Billing Specialist to manage patient eligibility and insurance claims with accuracy. You will handle daily billing tasks, verify coverages, and respond to inquiries while ensuring compliance with HIPAA and regulatory standards.

The role requires a high school diploma and a Pharmacy Technician license, with 1+ years of experience preferred. On-site work in Englewood, CO, with competitive pay and benefits.