Pharmacy Technician - Billing Specialist

Guardian Pharmacy, LLC; Gainesville (VA); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

401(k) with company match

Medical, Dental and Vision

Job summary

JobRx, Inc. in Gainesville, VA is seeking a Pharmacy Billing Specialist responsible for processing patient billing and insurance claims with accuracy and timeliness.

You will support daily and month-end billing, maintain patient records, and respond to billing inquiries from patients, providers, and carriers. The role requires high attention to detail, ability to work independently, and comfort with HIPAA regulations.

Qualifications

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

Responsibilities

• Research and establish patient eligibility coverage with insurance providers; enter/update patient/insurance information into billing system.
• Maintain and audit patient files and documentation to defend third-party audits; enter patient information into pharmacy system.
• Respond to billing inquiries via phone/electronic communications; resolve issues related to eligibility, coverage, and benefits.
• Review Medicare plan options during open enrollment; assess patient profiles and insurance coverage to help residents save money.
• Handle daily census and facility-related administrative tasks; process payments, returns, and credits.

Skills

Work Ethic/Integrity

Relational

Strategy and Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration

National Certification (PTCB) preferred

Tools

Pharmacy information system

Job description

Gainesville, Virginia, United States of America

Job Summary

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 open availability required between 7:30 am and 8 pm. Rotating weekend schedule.

Attributes Required

• Work Ethic/Integrity – intrinsic drive to excel aligned with company philosophy
• Relational – ability to build relationships with business unit management and serve as a "trusted advisor"
• Strategy and Planning – think ahead, plan, and manage time efficiently
• Problem Solving – analyze causes and solve problems at the functional level
• Team Oriented – work effectively and collaboratively with all team members

Essential 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 enter and/or update patient/insurance information into the 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 residents or responsible parties 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, and Third‑Party Insurances).
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements, including processing prior authorizations, resolving rejections, producing reports and completing 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/or 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 work environment characteristics described here are representative of those an employee encounters while performing the job.

• 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 an office environment.
• Ability to work flexible hours.

Benefits

Guardian provides employees with a comprehensive Total Rewards package, supporting our core value of "Treat others as you would like to be treated."

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