Pharmacy Billing Specialist

Guardian Pharmacy; Cedar Rapids (IA); On-site; USD 40,000 - 60,000; Full time

Job summary

Right Dose Pharmacy in Cedar Rapids, IA is seeking a billing specialist to process customer bills and insurance claims accurately and on time. You will support daily and month-end billing functions and provide excellent service to patients, caregivers, medical providers, and insurers.

As part of the Guardian family of pharmacies, you will join a fast-growing team focused on accurate billing, patient advocacy, and streamlined revenue cycle processes in a dynamic healthcare environment.

Qualifications

• Intrinsic drive to excel with company values.
• Ability to build relationships with management and become “trusted advisor.”
• Ability to think ahead, plan and manage time efficiently.
• Ability to analyze causes and solve problems at functional level.
• Ability to work effectively and collaboratively with all team members.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers and update patient/insurance information in billing system.
• Maintain and audit patient files and documentation to defend third party audits and ensure payer compliance.
• Provide timely responses to billing inquiries via phone or electronic communications and resolve issues.
• Run Medicare plan comparisons during open enrollment to help residents save money.
• Manage daily census, admit, discharge, and room changes for facilities.
• Process patient payments, returns, and credits; transmit credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payment plans.
• Organize requested audit documentation for timely responses.
• Adjudicate prescription claims and communicate with insurers about rejected claims.

Skills

Work Ethic/Integrity

Relational

Strategy and Planning

Problem Solving

Team Oriented

Job description

Cedar Rapids, Iowa, United States of America

Extraordinary Care. Extraordinary Careers.

With one of the nation’s largest, most innovative long-term care pharmacy services providers, there is no limit to the growth of your career.

Right Dose Pharmacy, a member of the Guardian family of pharmacies, has an exciting opportunity for you to join our rapidly growing team in Cedar Rapids, Iowa.

Why Right Dose Pharmacy? We’re reimagining medication management and transforming care.

Who We Are And What We’re About

Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. With our comprehensive suite of tech-enabled pharmacy services and a dedicated team of professionals committed to enriching the lives of those we serve, we are redefining how pharmacy care is delivered.

We offer an opportunity to learn and grow your career in a fast-paced, diverse, and inclusive environment. If you are looking for a challenging, team-oriented environment in which you can put your expertise to work, then this is the place for you.

SCHEDULE: MONDAY- FRIDAY VARYING SHIFTS FROM 6A-7P.

Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month-end billing functions, procedures and reporting. Provides excellent customer service to patients, caregivers, medical providers and insurance carriers.

Required

ATTRIBUTES REQUIRED:

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Relational – ability to build relationships with business unit management and become “trusted advisor.”
• Strategy and Planning – ability to think ahead, plan and manage time efficiently.
• Problem Solving – ability to analyze causes and solve problems at functional level.
• Team Oriented – ability to work effectively and collaboratively with all team members.

ESSENTIAL JOB FUNCTIONS (include The Following)

• Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities. Reverify benefit coverage criteria as needed for claims follow up. Accurately enters and/or updates patient/insurance information into billing system.
• Maintain and continually audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance. Accurately enter patient information into the pharmacy system.
• Provide assistance and timely response to all billing customer inquiries via phone or electronic communications. Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods. Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money.
• Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned.
• Process patient payments, returns, and credits. Transmit individual credit card payments as needed.
• May pursue payment from delinquent accounts and make payment arrangements.
• Research, identify and organize requested audit documentation in timely manner.
• Perform prescription claims adjudication including communication with insurance companies regarding rejected claims