Pharmacy Billing Specialist

CommuniCare Health; Northern (KY); Hybrid; USD 29,000 - 32,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Job summary

CommuniCare Health is seeking a Pharmacy Billing Specialist to manage patient accounts and ensure accurate billing across payers. You will verify insurance details, work with Medicare Part D and managed care, and collaborate with multiple facilities to resolve census clarifications.

The role emphasizes adherence to HIPAA guidelines, ongoing review of billing reports, and collaboration with hospice and third-party plans to maintain compliant, timely invoicing.

Qualifications

• Must follow billing processes per manual for consistency and compliance.
• Experience with Medicare Part D, Medicaid and managed care plans is preferred.
• Knowledge of HIPAA guidelines and patient privacy requirements.

Responsibilities

• Follow all billing processes as outlined to ensure consistency and prescription integrity.
• Maintain and update patient accounts by verifying or editing current insurance details.
• Collaborate with facility business office managers for Medicare Part D plans and census clarifications.
• Work with hospice and third-party plans as needed.
• Review SQL reports daily to ensure clean facility invoices.
• Perform other billing-related duties as assigned.
• Adhere to federal and state regulations and company policies.

Skills

Billing processes

Insurance verification

Medicare Part D

Medicaid

Commercial insurance

HIPAA compliance

SQL reports

Long-Term Care pharmacy experience

Attention to detail

Tools

SQL

Framework LTC

Job description

## Pharmacy Billing SpecialistApplylocations: Pharmacy Solutions Group - West Virginiatime type: Full timeposted on: Posted Todayjob requisition id: R-0000118070**Job Address:**15063 MacCorkle AvenueCabin Creek, WV 25035**Job Description:** Pharmacy Billing Specialist**Reports to**: Pharmacy Billing Supervisor**Job Type**: Full-Time – Hybrid/Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland**Pay Rate:** $21-23/hr**Position Overview**: Manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the billing manual.**Key Responsibilities**:* Follow all billing processes as outline in the billing manual to ensure consistency and prescription integrity for compliance* Maintain all current patient accounts by verifying, adding or editing current insurance (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care)* Works closely with the facility business office managers for Medicare Part D insurance plans and Census clarifications* Works directly with several hospice plans and third party plans as needed* Daily reviews of SQL reports setup to ensure a clean facility invoice* Any other assigned duties that relates to billing* Follow federal and state regulations* Adhere to company policies and procedures* Follow HIPPA guidelines and regulations**Qualifications**:* Previous Long-Term Care pharmacy experience a plus (but not required)* Knowledge of Framework LTC a plus (but not required)**Salary and Benefits**:* Competitive salary commensurate with experience* Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more### About UsSince 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.