Pharmacy Billing & Claims Specialist

Guardian Pharmacy, LLC; Ormond Beach (FL); On-site; USD 36,000 - 52,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) with company match

Comprehensive training provided

Competitive pay

Paid holidays and vacation

Job summary

Guardian Pharmacy of Daytona in Ormond Beach, FL is seeking a Billing Specialist to manage patient billing and insurance claims on-site. The role emphasizes accuracy, timely processing, and strong customer service for patients, caregivers, and providers.

You will handle Medicare/Medicaid and private plan interactions, maintain census and billing records, and collaborate with teams to resolve issues while following HIPAA and regulatory requirements. Training and full benefits are provided.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB).
• 1+ years of related experience.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers; enter/update patient information into billing system.
• Maintain and audit patient files and documentation for third‑party audits; ensure payer and company compliance.
• Respond to billing inquiries via phone or electronic communications; resolve patient billing issues related to eligibility and benefits.
• Review patient profiles to evaluate options to save residents money; run Medicare plan comparisons during open enrollment.
• Handle daily census tasks, admissions, discharges, and room changes for facilities assigned.
• Process payments, returns, and credits; transmit credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payments as necessary.
• Adjudicate prescription claims and resolve rejections with insurers; rebill as needed.
• Develop knowledge of Medicare, Medicaid, PDPs and Third-Party Insurances; use pharmacy systems to meet regulatory requirements.
• Rotate through departments to gain knowledge of workflows; adhere to HIPAA and team collaboration.

Skills

Attention to detail

Problem solving

Clear communication

Teamwork

Relational

Time management

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration (state)

National Certification preferred (PTCB)

Tools

Pharmacy information system

Advanced computer skills

Job description

Guardian Pharmacy of Daytona in Ormond Beach, FL is seeking a Billing Specialist to manage patient billing and insurance claims on-site. The role emphasizes accuracy, timely processing, and strong customer service for patients, caregivers, and providers.

You will handle Medicare/Medicaid and private plan interactions, maintain census and billing records, and collaborate with teams to resolve issues while following HIPAA and regulatory requirements. Training and full benefits are provided.