Pharmacy Billing Specialist

About the role

Right Dose Pharmacy, a member of the Guardian family of pharmacies, is seeking a dedicated and skilled individual to join our team in Cedar Rapids, Iowa. 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
• Maintain and audit patient files and documentation
• Enter and update patient/insurance information into the billing system
• Respond to billing customer inquiries via phone or electronic communications
• Resolve patient billing issues regarding insurance eligibility, coverage, and benefits
• Run Medicare plan comparisons during open enrollment and special enrollment periods
• Evaluate options to save resident money
• Process daily census, admit, discharge, and room changes for assigned facilities
• Handle patient payments, returns, and credits
• Pursue payment from delinquent accounts and make payment arrangements
• Organize requested audit documentation
• Perform prescription claims adjudication, communicate with insurance companies, and make necessary corrections
• Develop knowledge and proficiency in pharmacy facility billing requirements and systems
• Rotate through other departments to gain functional knowledge of workflows
• Adhere to applicable government regulations, including HIPAA
• Collaborate with team members to meet service goals

Requirements

• National certification (PTCB or NHA)
• Varying shifts: Monday-Friday, 8AM-6PM

Qualifications

• High school diploma or GED
• 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
• Attention to detail and accuracy
• Ability to work in a fast-paced, team-oriented environment

Skills

• Work ethic/integrity
• Relational
• Strategy and planning
• Problem solving
• Team oriented

Benefits

Guardian offers a comprehensive Total Rewards package, including:

• Competitive pay
• 401(k) with company match
• Family, health, and insurance benefits (for full-time employees working 30+ hours/week)
• Medical, dental, and vision coverage
• Health savings accounts and flexible spending accounts
• Company-paid life, accidental death & dismemberment, long-term disability, and short-term disability
• Dependent care flexible spending accounts
• Wellbeing employee assistance program (EAP)
• Time off (paid holidays and sick days, generous vacation benefits based on years of service)

What We Offer

At Guardian, we believe in treating others as we would like to be treated. We offer a supportive and inclusive environment where your voice and talents are valued. Join us to discover what your best work truly looks like.