Pharmacy Billing Specialist

guardianpharmacy; Orlando (FL); On-site; USD 32,000 - 46,000; Full time

Job summary

Guardian Pharmacy of Orlando in Orlando, FL, is seeking a Pharmacy Billing Specialist to handle patient billing and insurance claims over the phone in a high-volume, onsite setting at a closed-door pharmacy. Training is provided, and the role requires comfort with fast-paced billing operations.

The position emphasizes accuracy, regulatory compliance (HIPAA), and collaboration with care teams. Work hours are Monday–Friday, with potential extended hours during billing cycles.

Qualifications

• High school diploma or GED required.
• Pharmacy Technician license/certification/registration per state.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Maintain and audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance.
• Provide responses to all billing inquiries via phone or electronic communications.
• Run Medicare plan comparisons during open enrollment and special enrollment periods to help residents save money.
• Process daily census, admit, discharge, and room changes for facilities assigned.
• Process patient payments, returns, and credits; transmit credit card payments as needed.
• Perform prescription claims adjudication with insurers and resolve rejections or issues as needed.

Skills

Work Ethic

Relational

Strategy and Planning

Problem Solving

Team Oriented

Education

High School Diploma

Pharmacy Technician license

Job description

Orlando, Florida, United States of America Extraordinary Care. Extraordinary Careers.

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

Why Guardian Pharmacy of Orlando ? 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 8:30-5pm; Departement hours are 7am-7:00pm. So if there is a coverage issue the above hours might alter. Also at end of billing cycle each month some extended hours and occasional weekend.

This role will be performed onsite at a closed-door pharmacy in Orlando, FL. All patient interactions will be over the phone.

Comprehensive training provided side by side with training team.

Must be comfortable working in a high-volume environment.

Must be registered with the Florida Pharmacy Board Registry.

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.

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, eligibility, prior authorizations or other issues as needed. Make corrections as needed and rebill claims as necessary.
• Develop knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances)
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions.
• Rotate through other departments to gain working/functional knowledge of other department workflows.
• 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