Pharmacy Billing Specialist III

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.

Requirements

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB).
• CPT License (preferred).

Essential Job Functions

• 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 billing system.
• Maintain and audit patient files and documentation.
• Provide assistance and timely responses to billing customer inquiries.
• Resolve patient billing issues regarding insurance eligibility, coverage, and benefits.
• Run Medicare plan comparisons during open and special enrollment periods.
• Evaluate and recommend cost-saving options for residents.
• Manage daily census, admit, discharge, and room changes.
• Process patient payments, returns, and credits.
• Transmit credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payment plans.
• Organize and provide requested audit documentation.
• Perform prescription claims adjudication, communicate with insurance companies, and correct/rebill claims.
• Develop knowledge and proficiency in pharmacy facility billing requirements and systems.
• Rotate through other departments to gain functional knowledge.
• Follow applicable government regulations, including HIPAA.
• Work collaboratively with team members to meet service goals.

Qualifications

• 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.
• Ability to handle stressful situations and deadlines.
• Quality-minded and motivated to seek out errors and inquire about inaccuracies.

Benefits

• Competitive pay.
• 401(k) with company match.
• Family, health, and insurance benefits (for full-time employees working 30+ hours/week).
• Medical, dental, and vision health savings accounts and flexible spending accounts.
• Company-paid basic life and accidental death & dismemberment insurance.
• Long-term disability and optional short-term disability insurance.
• 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

Guardian provides a comprehensive Total Rewards package, including compensation, financial benefits, and more. The company supports its core value of treating others as they would like to be treated. Guardian also offers a variety of wellness programs and an employee assistance program (EAP).

Work Environment

The work environment is usually low to moderate in noise level. Employees must interact effectively with others in an office setting, manage conflicts, and handle stressful situations and deadlines. Desk work in an office environment is required. Ability to work flexible hours is important.

Additional Information

The position is 100% on-site. Guardian Pharmacy of Michigan is part of the Guardian family of pharmacies and is located in Grand Rapids, Michigan. The company is reimagining medication management and transforming care for healthcare organizations serving seniors and individuals with complex care needs. Guardian encourages innovative thinking, intellectual curiosity, and diverse viewpoints to stay competitive in today's dynamic business environment.