Pharmacy Billing Specialist I – Claims & Enrollment

Guardian Pharmacy; Pink Hill (NC); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

401(k) with company match

Medical, Dental and Vision

Paid holidays and generous vacation

Job summary

Southern Pharmacy Services in Pink Hill, North Carolina is seeking a billing specialist to process customer bills and insurance claims accurately and on time. You will support daily and month-end billing activities, respond to inquiries, and help ensure payer and company compliance while delivering excellent service to patients, caregivers, providers, and insurers.

Join a fast-paced, team-oriented environment within the Guardian family and grow your career in a company that values integrity and

Qualifications

• 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
• Quality minded; motivated to seek out errors and inquire about inaccuracies.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers.
• Maintain and audit patient files and documentation necessary to defend third party audits and ensure payer and company compliance.
• 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.
• 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.
• 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

Experience

Attention to detail

Independent worker

Fast-paced environment

Education

High School Diploma or GED

Pharmacy Technician license/certification

PTCB certification preferred

Tools

Pharmacy information system

Job description

Southern Pharmacy Services in Pink Hill, North Carolina is seeking a billing specialist to process customer bills and insurance claims accurately and on time. You will support daily and month-end billing activities, respond to inquiries, and help ensure payer and company compliance while delivering excellent service to patients, caregivers, providers, and insurers.

Join a fast-paced, team-oriented environment within the Guardian family and grow your career in a company that values integrity and