Billing Specialist
Guardian Pharmacy, Eden Prairie, MN, United States
Location: Eden Prairie, Minnesota, United States of America.
Starting Pay Range: $24 - $27 per hour.
Job Overview
Guardian Pharmacy of Minnesota is seeking a Billing Associate to process customer bills and insurance claims accurately and in a timely manner. The role involves daily and month‑end billing functions, procedures, and reporting, while providing excellent customer service to patients, caregivers, medical providers, and insurance carriers.
Responsibilities
Research and establish patient eligibility coverage with insurance providers, including private individuals and 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.
Complete 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 establish 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 necessary and rebill claims as required.
Develop knowledge and understanding of 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; use systems to process prior authorizations, resolve rejections, produce various reports, and complete billing functions.
Rotate through other departments to gain functional knowledge of other departmental workflows.
Follow all applicable government regulations, including HIPAA.
Work as a collaborative team member to meet the service goals of the pharmacy.
Perform other essential functions and duties as assigned.
Qualifications
High School Diploma or GED required.
Pharmacy Technician license/certification/registration required per state requirements; National Certification preferred (PTCB).
Required attributes:
Work ethic/integrity: intrinsic drive to excel aligned with company values.
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 the functional level.
Team oriented: ability to work effectively and collaboratively with all team members.
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.
Benefits
Competitive pay
401(k) with company match
Medical, Dental and Vision insurance (full‑time only)
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 coverage
Dependent Care Flexible Spending Accounts
Employee Assistance Program (EAP)
Guardian Angels employee assistance fund
Paid holidays and sick days
Generous vacation benefits based on years of service
Guardian Pharmacy of Minnesota is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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Starting Pay Range: $24 - $27 per hour.
Job Overview
Guardian Pharmacy of Minnesota is seeking a Billing Associate to process customer bills and insurance claims accurately and in a timely manner. The role involves daily and month‑end billing functions, procedures, and reporting, while providing excellent customer service to patients, caregivers, medical providers, and insurance carriers.
Responsibilities
Research and establish patient eligibility coverage with insurance providers, including private individuals and 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.
Complete 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 establish 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 necessary and rebill claims as required.
Develop knowledge and understanding of 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; use systems to process prior authorizations, resolve rejections, produce various reports, and complete billing functions.
Rotate through other departments to gain functional knowledge of other departmental workflows.
Follow all applicable government regulations, including HIPAA.
Work as a collaborative team member to meet the service goals of the pharmacy.
Perform other essential functions and duties as assigned.
Qualifications
High School Diploma or GED required.
Pharmacy Technician license/certification/registration required per state requirements; National Certification preferred (PTCB).
Required attributes:
Work ethic/integrity: intrinsic drive to excel aligned with company values.
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 the functional level.
Team oriented: ability to work effectively and collaboratively with all team members.
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.
Benefits
Competitive pay
401(k) with company match
Medical, Dental and Vision insurance (full‑time only)
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 coverage
Dependent Care Flexible Spending Accounts
Employee Assistance Program (EAP)
Guardian Angels employee assistance fund
Paid holidays and sick days
Generous vacation benefits based on years of service
Guardian Pharmacy of Minnesota is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
#J-18808-Ljbffr