Pharmacy Technician - Billing Specialist

Guardian Pharmacy; Gainesville (VA); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Medical, Dental and Vision

401(k) with company match

Paid time off

Job summary

Guardian Pharmacy in Gainesville, Virginia is hiring a Pharmacy Billing Specialist to manage patient eligibility and processing of insurance claims with accuracy and timeliness.

The ideal candidate has a high school diploma, Pharmacy Technician certification, and 1+ year of related experience, plus strong computer skills. This full-time on-site role offers comprehensive benefits and growth opportunities.

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 including private individuals and/or government entities.
• Accurately enter patient information into the pharmacy system and maintain/ audit patient files.
• Provide timely responses to billing inquiries via phone or electronic communications; resolve issues with eligibility and coverage.
• Run Medicare plan comparisons during open enrollment and special enrollment periods to help residents save money.
• Complete daily census, admit, discharge, and room changes for facilities.
• Process patient payments, returns, and credits; transmit credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payments when necessary.
• Research and organize requested audit documentation for third-party audits.
• Manage prescription claims adjudication including communications with insurers for rejections or prior authorizations.

Skills

Attention to detail

Customer service

Billing experience

Education

High school diploma or GED

Pharmacy Technician license/certification

Tools

Pharmacy information system

MS Office

Job description

Gainesville, Virginia, United States of America

About the Role

With one of the nation’s largest, most innovative long-term care pharmacy services providers, there is no limit to the growth of your career. Southern Pharmacy Services, a member of the Guardian family of pharmacies, has an exciting opportunity for you to join our rapidly growing team in Gainesville, Virginia. We’re reimagining medication management and transforming care. Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs.

Responsibilities

• 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.

Schedule

Monday – Friday with open availability required between 7:30 am and 8 pm. Rotating weekend schedule.

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 a 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.

Job Functions

• 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 a 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 Certifications

• High school diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required.

Skills 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.

Work Environment

• The noise level in the work environment is usually low to moderate.
• Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.
• Requires desk work in office environment.
• Ability to work flexible hours.

Compensation and Benefits

Compensation & Financial

• Competitive pay
• 401(k) with company match

Family, Health & Insurance Benefits (Full‑Time employees working 30+ hours/week only)

• Medical, Dental and Vision
• Health Savings Accounts and Flexible Spending Accounts
• Company-paid Basic Life and Accidental Death & Dismemberment
• Company-paid Long-Term Disability and optional Short-Term Disability
• Voluntary Employee and Dependent Life, Accident and Critical Illness
• Dependent Care Flexible Spending Accounts

Wellbeing

• Employee Assistance Program (EAP)
• Guardian Angels (Employee assistance fund)

Time Off

• Paid holidays and sick days
• Generous vacation benefits based on years of service

Guardian Difference

Our clients require pharmacy services that aren’t “cookie‑cutter.” That’s why every Guardian pharmacy is locally operated and empowered with the autonomy to tailor their business to meet their clients’ needs. Our corporate support offices, based in Atlanta, Ga., provide services such as human resources, business intelligence, legal, and marketing to promote the success of each Guardian location. Regardless of your role at Guardian, your voice and talents matter. Because healthcare is an ever-changing industry, we encourage innovative thinking, intellectual curiosity, and diverse viewpoints to ensure we stay competitive in today’s dynamic business environment. At Guardian, we are dedicated to fostering and advancing a diverse and inclusive workforce.

Join Us

Join us to discover what your best work truly looks like.