Billing Specialist

About the role

Middle Tennessee Pharmacy Services, a member of the Guardian family of pharmacies, is seeking a dedicated and skilled individual to join our team in Murfreesboro, Tennessee. We are a forward-thinking organization that redefines how pharmacy care is delivered, focusing on customized medication management solutions for healthcare organizations serving seniors and individuals with complex care needs.

Responsibilities

• Process customer bills and insurance claims accurately and promptly.
• Assist with daily and monthly billing functions, including reporting.
• Provide excellent customer service to patients, caregivers, medical providers, and insurance carriers.
• Research and establish patient eligibility coverage with insurance providers.
• Reverify benefit coverage criteria as needed for claims follow-up.
• Accurately enter and update patient/insurance information into the billing system.
• Maintain and audit patient files and documentation to ensure payer and company compliance.
• Enter patient information into the pharmacy system.
• Respond to billing customer inquiries via phone or electronic communications.
• Resolve patient billing issues regarding insurance eligibility, coverage, and benefits.
• Provide guidance and support to residents or responsible parties during open and special enrollment periods.
• Evaluate and recommend cost-saving options for residents.
• Manage daily census, admit, discharge, and room changes for assigned facilities.
• Process patient payments, returns, and credits.
• Transmit credit card payments as needed.
• Pursue payment from delinquent accounts and make payment arrangements.
• Organize and provide requested audit documentation in a timely manner.
• Perform prescription claims adjudication, communicate with insurance companies, and make necessary corrections and rebills.
• Develop knowledge and proficiency in pharmacy facility billing requirements and systems.
• Rotate through other departments to gain functional knowledge of department workflows.
• Follow applicable government regulations, including HIPAA.
• Work collaboratively with team members to meet service goals.

Requirements

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB).
• 1+ years of related experience.
• Advanced computer skills; pharmacy information system experience preferred.
• Ability to work independently and meet deadlines.
• Great attention to detail and accuracy.
• Ability to work in a fast-paced, team-oriented environment.

Qualifications

• Strong work ethic and integrity.
• Excellent relational skills and ability to build relationships with business unit management.
• Strategic and planning abilities.
• Problem-solving skills.
• Team-oriented mindset.

Skills

• Advanced computer skills.
• Pharmacy information system experience.
• Independent work ability.
• Attention to detail.
• Collaborative teamwork.

Benefits

Guardian offers a comprehensive Total Rewards package, including competitive pay, a 401(k) with company matching, and a range of benefits such as medical, dental, and vision insurance, health savings accounts, flexible spending accounts, life and accident insurance, dependent care flexible spending accounts, a well-being program, and an employee assistance program. Guardian also supports diversity and inclusion, fostering a workplace where everyone's voice and talents are valued.