Pharmacy Billing Specialist
Guardian Pharmacy, Cincinnati, OH, United States
Cincinnati, Ohio, United States of America
Schedule
Monday - Friday: 10:00 am - 6:00 pm
Saturdays: 3:00 pm - 4:00 pm (rotates once every 9 weeks)
Pay Range
$19.00 - $26.40 per hour
Responsibilities
Responsible for processing customer bills and insurance claims accurately and in a timely manner, including daily and month‑end billing functions, procedures, and reporting. Provides excellent customer service to patients, caregivers, medical providers, and insurance carriers.
Required Attributes
Work ethic and integrity – intrinsic drive to excel
Relational – ability to build relationships with business unit management and become a trusted advisor
Strategy and planning – think ahead, plan, and manage time efficiently
Problem solving – analyze causes and solve functional level problems
Team oriented – work effectively and collaboratively with all team members
Essential Job Functions
Research and establish patient eligibility coverage with insurance providers; reverify benefit coverage criteria and update patient/insurance information in the billing system.
Maintain and audit patient files and documentation for third‑party audits and payer/company compliance.
Respond to billing customer inquiries via phone or electronic communication; research and resolve patient billing issues regarding insurance eligibility and coverage.
Provide guidance to residents or responsible parties on Medicare plan comparisons during enrollment periods and review patient profiles to evaluate cost‑saving options.
Complete daily census, admit, discharge, and room changes for assigned facilities.
Process patient payments, returns, and credits; transmit individual credit card payments.
Pursue payment from delinquent accounts and arrange payment plans.
Research and organize requested audit documentation promptly.
Adjudicate prescription claims and communicate with insurance companies regarding rejected claims, prior authorizations, and other issues; make corrections and rebill as necessary.
Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, and third‑party insurance).
Utilize pharmacy information systems for prior authorizations, resolution of rejections, report production, and billing functions.
Rotate through other departments to gain functional knowledge of their workflows.
Follow all applicable government regulations, including HIPAA.
Collaborate with the team to meet pharmacy service goals.
Education and Certifications
High School Diploma or GED required.
Pharmacy Technician license/certification/registration per state requirements; National Certification (PTCB) preferred or required.
Skills and Qualifications
1+ year related experience.
Advanced computer skills; pharmacy information system experience preferred.
Independent work style with ability to meet deadlines.
Great attention to detail and accuracy.
Capacity to excel in a fast‑paced, team‑oriented environment and handle multiple tasks simultaneously.
Quality mindset; proactive in identifying errors and seeking clarification.
Work Environment
Low to moderate noise level.
Collaborative office environment; effective interaction and conflict management required.
Desk work in office setting; flexible hours acceptable.
Benefits
Competitive pay.
401(k) with up to 3.5% company match.
Health plans (HSA, FSA‑eligible).
Wellness incentive program.
Dental and vision plans.
Company‑paid basic life, AD&D, and long‑term disability coverage.
Optional life, AD&D, accident, critical illness, and short‑term disability coverage.
Dependent Care Flexible Spending Accounts.
Employee Assistance Program.
Paid holidays and sick days; generous vacation benefits based on years of service; eligibility begins after 30 days for full‑time employees.
EEO Statement
The Guardian is an equal opportunity employer. We welcome a diverse workforce and are committed to inclusion.
Join Us
Join us to discover what your best work truly looks like.
#J-18808-Ljbffr
Schedule
Monday - Friday: 10:00 am - 6:00 pm
Saturdays: 3:00 pm - 4:00 pm (rotates once every 9 weeks)
Pay Range
$19.00 - $26.40 per hour
Responsibilities
Responsible for processing customer bills and insurance claims accurately and in a timely manner, including daily and month‑end billing functions, procedures, and reporting. Provides excellent customer service to patients, caregivers, medical providers, and insurance carriers.
Required Attributes
Work ethic and integrity – intrinsic drive to excel
Relational – ability to build relationships with business unit management and become a trusted advisor
Strategy and planning – think ahead, plan, and manage time efficiently
Problem solving – analyze causes and solve functional level problems
Team oriented – work effectively and collaboratively with all team members
Essential Job Functions
Research and establish patient eligibility coverage with insurance providers; reverify benefit coverage criteria and update patient/insurance information in the billing system.
Maintain and audit patient files and documentation for third‑party audits and payer/company compliance.
Respond to billing customer inquiries via phone or electronic communication; research and resolve patient billing issues regarding insurance eligibility and coverage.
Provide guidance to residents or responsible parties on Medicare plan comparisons during enrollment periods and review patient profiles to evaluate cost‑saving options.
Complete daily census, admit, discharge, and room changes for assigned facilities.
Process patient payments, returns, and credits; transmit individual credit card payments.
Pursue payment from delinquent accounts and arrange payment plans.
Research and organize requested audit documentation promptly.
Adjudicate prescription claims and communicate with insurance companies regarding rejected claims, prior authorizations, and other issues; make corrections and rebill as necessary.
Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, and third‑party insurance).
Utilize pharmacy information systems for prior authorizations, resolution of rejections, report production, and billing functions.
Rotate through other departments to gain functional knowledge of their workflows.
Follow all applicable government regulations, including HIPAA.
Collaborate with the team to meet pharmacy service goals.
Education and Certifications
High School Diploma or GED required.
Pharmacy Technician license/certification/registration per state requirements; National Certification (PTCB) preferred or required.
Skills and Qualifications
1+ year related experience.
Advanced computer skills; pharmacy information system experience preferred.
Independent work style with ability to meet deadlines.
Great attention to detail and accuracy.
Capacity to excel in a fast‑paced, team‑oriented environment and handle multiple tasks simultaneously.
Quality mindset; proactive in identifying errors and seeking clarification.
Work Environment
Low to moderate noise level.
Collaborative office environment; effective interaction and conflict management required.
Desk work in office setting; flexible hours acceptable.
Benefits
Competitive pay.
401(k) with up to 3.5% company match.
Health plans (HSA, FSA‑eligible).
Wellness incentive program.
Dental and vision plans.
Company‑paid basic life, AD&D, and long‑term disability coverage.
Optional life, AD&D, accident, critical illness, and short‑term disability coverage.
Dependent Care Flexible Spending Accounts.
Employee Assistance Program.
Paid holidays and sick days; generous vacation benefits based on years of service; eligibility begins after 30 days for full‑time employees.
EEO Statement
The Guardian is an equal opportunity employer. We welcome a diverse workforce and are committed to inclusion.
Join Us
Join us to discover what your best work truly looks like.
#J-18808-Ljbffr