Pharmacy Billing Specialist I: Claims & Eligibility

guardianpharmacy; Gainesville (VA); On-site; USD 42,000 - 48,000; Full time

Job summary

Southern Pharmacy Services in Gainesville, Virginia is seeking a Billing Specialist to manage patient billing and insurance claims with attention to accuracy and timeliness.

You will verify eligibility, enter data into the billing system, respond to inquiries, and assist with open enrollment and daily census tasks.

Open availability between 7:30 AM and 8:00 PM with rotating weekends reflects our dynamic schedule; strong teamwork and compliance are valued.

Qualifications

• High school diploma or GED required.
• Pharmacy technician license or registration per state.
• National Certification (PTCB) preferred.
• 1+ years of related experience.
• Advanced computer skills; familiarity with pharmacy systems.

Responsibilities

• Research and verify patient eligibility coverage with insurance providers.
• Enter and update patient information into the billing system with accuracy.
• Respond to billing inquiries via phone or electronic communications.
• Assist with open enrollment periods and compare Medicare plans.
• Maintain daily census, admits, discharges, and room changes for facilities.
• Process patient payments, returns, and credits; handle delinquent accounts as needed.
• Prepare and organize audit documentation for reviews.
• Adjudicate prescription claims and resolve insurance rejections or prior authorizations.

Skills

Work Ethic

Relational

Strategy & Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration

National Certification (PTCB) preferred

Job description

Southern Pharmacy Services in Gainesville, Virginia is seeking a Billing Specialist to manage patient billing and insurance claims with attention to accuracy and timeliness.

You will verify eligibility, enter data into the billing system, respond to inquiries, and assist with open enrollment and daily census tasks.

Open availability between 7:30 AM and 8:00 PM with rotating weekends reflects our dynamic schedule; strong teamwork and compliance are valued.