Pharmacy Billing Supervisor

WESTMINSTER SENIOR CARE PHARMACY; Orlando (FL); On-site; USD 60,000 - 85,000; Full time

Job summary

Longevity Scripts in Orlando, FL seeks a Pharmacy Billing Supervisor to oversee daily billing operations for pharmacy services, admissions, and adjudication. You will supervise billing office staff, ensure timely payments, and reconcile accounts receivable in coordination with the Pharmacy Controller.

The role requires experience with Medicare Part D, Medicaid, and third-party claims, strong organization and communication skills, and compliance with HIPAA. This is an Equal Opportunity Employer.

Qualifications

• 3-5 years LTC business office experience required.
• Working knowledge of Medicare Part D, Medicaid, managed care plans, commercial insurance, and third-party claim adjudication processes.
• Experience resolving insurance claim rejections, denials, and prior authorization issues preferred.
• Knowledge of long-term care pharmacy operations and nursing facility workflows preferred.
• Experience with pharmacy billing software systems preferred (e.g., Frameworks LTC).
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Strong organizational skills and ability to manage multiple priorities in a fast-paced environment.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Responsibilities

• Directs billing office staff in processing pharmacy services claims in accordance with internal policies and procedures and applicable laws.
• Maintains confidentiality of patient and employee information.
• Manages submission of claims with third party insurance, private pay residents, workers compensation, facility Medicare Part A and Managed Care charges.
• Provides leadership to billing staff regarding handling billing inquiries from sponsors or other responsible parties.
• Ensures reconciliation of third-party claims.
• Works with Pharmacy Controller to provide revenue information and develop strategies for maximizing gross margins.
• Oversees and coordinates billing office team in daily billing, credits, and remittances from third party plans.
• Maintains gain reports and timely cash collections.
• Performs month-end processes to ensure revenues are recorded accurately and timely.
• Collaborates with Westminster Communities for monthly pharmacy invoicing documentation.
• Responsible for daily remittance processing through NetRx, Sage 300, MHA, Inc.
• Maintains electronic records for all pharmacy receivables.
• Resolves rejections, denials, and prior authorizations for third-party claims.
• Educates staff on workflows and processes; coordinates hiring and training of billing staff.
• Interacts with facilities, physicians, and pharmacy team members; promotes teamwork and professionalism.
• Verifies and clarifies problems or inquiries with facility documentation requests/needs.
• Uses reference materials for ongoing training and education.
• Promotes customer service and brand image to support organizational mission.
• Handles various pharmacy office duties as assigned by Pharmacy Controller.
• In the absence of Pharmacy Controller, may serve as interim Controller.

Skills

Organizational skills

Verbal and written communication

Problem-solving

HIPAA compliance

Microsoft Office

Billing workflows

Tools

NetRx

Sage 300

Frameworks LTC

Job description

Longevity Scripts is seeking to fill a Pharmacy Billing Supervisor position at our pharmacy located in Orlando, FL. This position is responsible for supervising billing office staff in daily operations of admissions, billing, and adjudication of pharmacy services. This role will also oversee reconciliation of account receivables and develops methodology for prompt payment. EOE/DFWP - We honor those who serve.

Scope Of Responsibilities/Accountability

• Directs billing office staff in processing pharmacy services claims in accordance with internal policies and procedures, federal and state laws, as well as appliable professional standards to ensure that billing functions are performed accurately, timely, and in compliance with pharmacy service contracts.
• Maintains confidentiality of all patient and/or employee information to ensure patient and/or employee rights are protected.
• Manages submittal of claims with third party insurance, private pay residents, workers compensation, facility Medicare Part A and Managed Care charges including outlier charges, and house stock charges.
• Provides leadership and guidance to billing staff regarding positively handling billing inquiries from sponsors or other responsible parties.
• Ensures reconciliation of third-party claims
• Works with Pharmacy Controller to provide statistical revenue information and to develop strategies for maximizing gross margins.
• Oversees and coordinates billing office team members in daily billing, credits, and remittances from third party plans.
• Maintain gaining reports and timely cash collections
• Performs all month end processes to ensure all monthly revenues are recorded and reported accurately and in a timely manner.
• Works closely with Westminster Communities to provide all documentation necessary for accurate production of monthly pharmacy invoicing
• Responsible for daily remittance processing through designated software systems (i.e., NetRx, Sage 300, MHA, Inc.)
• Manage and maintain accurate electronic records for all pharmacy receivables.
• Responsible for resolution of rejections, denials, and prior authorizations associated with third party insurance claims (i.e., PDPs, Medicaid, etc.)
• Educates staff on proper processes and procedures to coordinate workflow
• Participates in the hiring process and coordinates the orientation and training of the billing staff
• Frequent interaction with facilities, physicians, and other pharmacy team members at all levels; promoting teamwork and demonstrates strong leadership skills and professionalism
• Verifies and clarifies any and all problems or inquiries with the facilities documentation requests/needs
• Utilize reference materials available to improve skills regularly including training and continuing education
• Promotes customer services and enhances brand image to support the overall organizational mission
• Various pharmacy office duties as determined by the Pharmacy Controller
• In the absence of the Pharmacy Controller, is able to stand in as interim Controller.

Essential Qualifications

• 3-5 years LTC Business office experience required
• Working knowledge of Medicare Part D, Medicaid, managed care plans, commercial insurance, and third-party claim adjudication processes.
• Experience resolving insurance claim rejections, denials, and prior authorization issues preferred.
• Knowledge of long-term care pharmacy operations and nursing facility workflows preferred.
• Experience with pharmacy management and billing software systems preferred (i.e., Frameworks LTC).
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong problem-solving and critical-thinking abilities.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Applicants can learn more about Florida background screening requirements at https://info.flclearinghouse.com/.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursued to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.