Pharmacy Billing Specialist

Guardian Pharmacy, LLC; Michigan; On-site; USD 65,904,000 - 68,770,000; Full time

Benefits offered by this job

401(k) with company match

Medical, Dental and Vision

Paid holidays and sick days

Generous vacation benefits

Job summary

Guardian Pharmacy Services in Brighton, Michigan is seeking a Billing Specialist III to process patient bills and insurance claims, ensure accurate data entry, and provide excellent customer service to patients, providers, and carriers.

This on-site role requires attention to detail, domain knowledge of Medicare/Medicaid billing, and the ability to handle daily census, open enrollment guidance, and complex billing tasks.

Qualifications

• 3+ years related experience including a minimum of 1 year at Billing Specialist II level.
• Advanced computer skills; pharmacy information system experience required
• Ability to work independently and deliver to deadlines.
• Great attention to detail and accuracy with fast-paced, team-oriented environment.

Responsibilities

• 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 audit patient files and documentation to defend third party audits and ensure payer compliance.
• Process patient payments, returns, and credits; transmit credit card payments as needed.
• Perform prescription claims adjudication and resolve issues with insurance providers.
• Follow HIPAA regulations and work collaboratively to meet service goals.

Skills

Billing experience

Independent work

Attention to detail

Advanced computer skills

Education

High School Diploma or GED

Pharmacy Technician certification

National Certification (PTCB) preferred

Tools

Pharmacy information systems

Job description

Brighton, Michigan, 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. Guardian Pharmacy of Eastern Michigan, a member of the Guardian family of pharmacies, has an exciting opportunity for you to join our rapidly growing team in Brighton, Michigan.

Why Guardian Pharmacy of Eastern Michigan? 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 8:30 am - 5:30 pm Pay Range $23 - $24 per hour **This position is 100 % on-site**.

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. The Billing Specialist III serves as a subject matter expert and departmental resource.

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.
• Using advanced knowledge, independently, troubleshoot, research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Uses advanced knowledge to independently resolve customer service issues that require judgement and critical thinking.
• 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, eligibility, prior authorizations or other issues as needed.
• Make corrections as needed and rebill claims as necessary.
• Through prior experience and cross training, demonstrate advanced knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions
• Serve as subject matter expert and departmental resource in Pharmacy information systems and workflow.
• This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions in a timely manner and with a high degree of accuracy.
• Consistently exceed pharmacy's established accuracy and productivity levels.
• Follow all applicable government regulations including HIPAA.
• Work as a collaborative team member to meet the service goals of the pharmacy.
• Other essential functions and duties may be assigned as needed.

EDUCATION AND/OR CERTIFICATIONS

High School Diploma or GED required. Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).

SKILLS AND QUALIFICATIONS

3+ years related experience including a minimum of 1 year at Billing Specialist II level. Advanced computer skills; pharmacy information system experience required Ability to work independently and deliver to deadlines. Great attention to detail and accuracy Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines Quality minded; motivated to seek out errors and inquire about inaccuracies.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the job. The noise level in the work environment is usually low to moderate. Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. Requires desk work in office environment. Ability to work flexible hours.

What We Offer

Guardian provides employees with a comprehensive Total Rewards package, supporting our core value of, “Treat others as you would like to be treated.”

• Compensation & Financial Competitive pay
• 401(k) with company match
• Family, Health & Insurance Benefits (Full-Time employees working 30+ hours/week only)
• Medical, Dental and Vision Health Savings Accounts and Flexible Spending Accounts
• Company-paid Basic Life and Accidental Death & Dismemberment
• Company-paid Long-Term Disability and optional Short-Term Disability
• Voluntary Employee and Dependent Life, Accident and Critical Illness
• Dependent Care Flexible Spending Accounts
• Wellbeing Employee Assistance Program (EAP) Guardian Angels (Employee assistance fund)
• Time Off Paid holidays and sick days
• Generous vacation benefits based on years of service

The Guardian Difference

Our clients require pharmacy services that aren’t “cookie cutter.” That’s why every Guardian pharmacy is locally operated and empowered with the autonomy to tailor their business to meet their clients’ needs. Our corporate support offices, based in Atlanta, Ga., provide services such as human resources, business intelligence, legal, and marketing to promote the success of each Guardian location. Regardless of your role at Guardian, your voice and talents matter. Because healthcare is an ever-changing industry, we encourage innovative thinking, intellectual curiosity, and diverse viewpoints to ensure we stay competitive in today’s dynamic business environment. At Guardian, we are dedicated to fostering and advancing a diverse and inclusive workforce. Join us to discover what your best work truly looks like.

Guardian Pharmacy Services is one of the largest and most innovative long-term care pharmacy companies in the U.S.

Our nationwide network of locally operated pharmacies delivers 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, Guardian is redefining how pharmacy care is delivered.

For more information, please visit www.guardianpharmacy.com

Guardian Pharmacy Services is an equal opportunity employer and provides equal opportunity in employment for all qualified persons, without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Guardian Pharmacy takes reasonable steps to protect personal information of applicants.

As part of our interview and hiring process, Guardian will never ask for financial, banking, or other personal identity information via phone, email, or chat nor would we ask that you purchase equipment or gift cards as part of the hiring process. All steps in the hiring process, including interviews, will be conducted by a Guardian employee or an approved vendor. Although we may use Zoom, Microsoft Teams, other similar communication platforms, we do not conduct interviews solely via the chat function in those platforms.