Pharmacy Billing Pro - Claims & Coverage Expert

guardianpharmacy; Cedar Rapids (IA); On-site; USD 32,000 - 45,000; Full time

Job summary

Right Dose Pharmacy in Cedar Rapids, IA is seeking a detail-oriented Billing Specialist to process patient billing and insurance claims accurately and on time.

You will handle daily and month-end billing tasks, respond to inquiries from patients, providers, and carriers, and support audit readiness while ensuring HIPAA compliance and high service levels in a fast-paced team environment.

Qualifications

• High School diploma or GED required.
• Pharmacy technician license/certification per state requirements; National Certification preferred.
• 1+ years of related experience.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Maintain and audit patient files and documentation for third party audits and compliance.
• Provide assistance and timely response to all billing inquiries via phone or electronic communications.
• Run Medicare plan comparisons during enrollment periods and review patient profiles for cost-saving options.
• Complete daily census, admit, discharge, and room changes for facilities assigned.
• Process patient payments, returns, and credits; transmit credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payment plans.
• Perform claims adjudication and communicate with insurers on rejections or prior authorizations.

Skills

Work Ethic/Integrity

Relational

Strategy and Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification

PTCB certification preferred

Tools

Pharmacy information system

Pharmacy software experience

Job description

Right Dose Pharmacy in Cedar Rapids, IA is seeking a detail-oriented Billing Specialist to process patient billing and insurance claims accurately and on time.

You will handle daily and month-end billing tasks, respond to inquiries from patients, providers, and carriers, and support audit readiness while ensuring HIPAA compliance and high service levels in a fast-paced team environment.