Senior Pharmacy Billing Specialist — On-Site

Guardian Pharmacy; Grand Rapids (MI); On-site; USD 48,000 - 50,000; Full time

Benefits offered by this job

Medical, Dental and Vision

401(k) with company match

Paid holidays and sick days

Generous vacation benefits

Job summary

Guardian Pharmacy of Michigan seeks a Billing Specialist III to join our Grand Rapids team. You will handle patient eligibility, insurance billing, and open enrollment activities with a focus on accuracy and compliance.

Responsibilities include processing claims, reconciling payments, auditing patient records, and providing proactive support to patients and providers. On-site schedule and 8:30am-5:30pm hours, with a competitive hourly wage.

Qualifications

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).
• 3+ years related experience including a minimum of 1 year at Billing Specialist II level.
• Advanced computer skills; pharmacy information system experience required
• 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.
• 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.
• Using advanced knowledge, independently, troubleshoot, research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Uses advanced knowledge to independently resolve customer service issues that require judgement and critical thinking.
• 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 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.
• Through prior experience and cross training, demonstrate advanced knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions
• Serve as subject matter expert and departmental resource in Pharmacy information systems and workflow.
• This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions in a timely manner and with a high degree of accuracy.
• Consistently exceed pharmacy's established accuracy and productivity levels.
• Follow all applicable government regulations including HIPAA.
• Work as a collaborative team member to meet the service goals of the pharmacy.

Skills

Work Ethic/Integrity

Relational

Strategy & Planning

Problem Solving

Team Oriented

Education

High School Diploma or GED

Pharmacy Technician license/certification/registration

Tools

Pharmacy information system

Job description

Guardian Pharmacy of Michigan seeks a Billing Specialist III to join our Grand Rapids team. You will handle patient eligibility, insurance billing, and open enrollment activities with a focus on accuracy and compliance.

Responsibilities include processing claims, reconciling payments, auditing patient records, and providing proactive support to patients and providers. On-site schedule and 8:30am-5:30pm hours, with a competitive hourly wage.