Pharmacy Billing Specialist - On-Site

About the role

With one of the nation’s largest, most innovative long-term care pharmacy services provider, Guardian Pharmacy of Maine, there is no limit to the growth of your career. This position is 100% on-site.

Responsibilities

• Reseach and establish patient eligibility coverage with insurance providers including private individuals and/or government entities.
• Reverify benefit coverage criteria as needed for claims follow up.
• Accurately enters and/or updates patient/insurance information into 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.
• Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money.
• Process patient payments, returns, and credits.
• Transmit individual credit card payments as needed.
• May pursue payment from delinquent accounts and make payment arrangements.
• Research, identify and organize requested audit documentation in 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 needed and rebill claims as necessary.
• Develop knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances).
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements.
• This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions.
• Rotate through other departments to gain working/functional knowledge of other department workflows.
• Follow all applicable government regulations including HIPAA.
• Work as a collaborative team member to meet the service goals of the pharmacy.

Requirements

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Relational – ability to build relationships with business unit management and become “trusted advisor.”
• Strategy and Planning – ability to think ahead, plan and manage time efficiently.
• Problem Solving – ability to analyze causes and solve problems at functional level.
• Team Oriented – ability to work effectively and collaboratively with all team members.

Qualifications

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

Skills

• 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

What We Offer Guardian provides employees with a comprehensive Total Rewards package, supporting our core value of, “Treat others as you would like to be treated.” Compensation & Financial Competitive pay
401(k) with company match
Family, Health & Insurance Benefits (Full-Time employees working 30+ hours/week only)
Medical, Dental and Vision
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
Dependent Care Flexible Spending Accounts
Wellbeing Employee Assistance Program (EAP)
Guardian Angels (Employee assistance fund)
Time Off
Paid holidays and sick days
Generous vacation benefits based on years of service

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the job. The noise level in the work environment is usually low to moderate. Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. Requires desk work in office environment.

Additional Information

Education And/Or Certifications High School Diploma or GED required.
Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific).