Pharmacy Billing Specialist — Claims & Payer Expert

Guardian Pharmacy, LLC; Minneapolis (MN); On-site; USD 30,000 - 36,000; Full time

Benefits offered by this job

Health benefits

Job summary

Guardian Pharmacy of Minnesota, Eden Prairie, MN, is seeking a Billing Specialist to join our team. You will verify patient insurance eligibility, recheck benefit criteria for claims, and update patient data in our billing system.

This role supports residency facilities by auditing files, processing payments, and resolving billing inquiries. You’ll collaborate with management and healthcare staff to optimize payer outcomes while ensuring HIPAA-compliant processes in a fast-paced environment.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required.
• 1+ years of related experience
• Advanced computer skills; pharmacy information system experience preferred.
• 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.

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 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.

Skills

Work Ethic/Integrity

Relational

Strategy and Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required

Tools

Pharmacy information system

Job description

Guardian Pharmacy of Minnesota, Eden Prairie, MN, is seeking a Billing Specialist to join our team. You will verify patient insurance eligibility, recheck benefit criteria for claims, and update patient data in our billing system.

This role supports residency facilities by auditing files, processing payments, and resolving billing inquiries. You’ll collaborate with management and healthcare staff to optimize payer outcomes while ensuring HIPAA-compliant processes in a fast-paced environment.