Pharmacy Technician - Billing Specialist

Guardian Pharmacy of Englewood, a member of the Guardian family of pharmacies, delivers customized medication-management solutions to healthcare organizations serving seniors and individuals with complex care needs. We offer a fast-paced, diverse, and inclusive environment where you can grow your career while transforming pharmacy care.

About the role

This position serves as a subject-matter expert and departmental resource for pharmacy billing, claims adjudication, and customer service. You will research insurance eligibility, troubleshoot billing issues, process payments, and ensure compliance with Medicare, Medicaid, PDPs, and third-party insurers.

Schedule

Monday – Friday, 8:00 am – 7:00 pm (variable shifts)

Pay

$24.00 – $28.00 per hour

Responsibilities

• Research and establish patient eligibility coverage with insurance providers, including private and government entities; reverify benefit criteria as needed.
• Accurately enter and update patient/insurance information into the billing system.
• Maintain and audit patient files and documentation to defend third-party audits and ensure payer and company compliance.
• Provide timely responses to billing inquiries via phone or electronic communications; independently troubleshoot and resolve patient billing issues.
• Guide residents or responsible parties through Medicare plan comparisons during open enrollment and special enrollment periods; evaluate drug regimens and insurance coverage to identify cost-saving options.
• Complete daily census, admit, discharge, and room-change tasks for assigned facilities.
• Process patient payments, returns, credits, and individual credit-card transactions; pursue payment on delinquent accounts and set up payment arrangements.
• Research, identify, and organize requested audit documentation in a timely manner.
• Adjudicate prescription claims, communicate with insurance companies regarding rejections, eligibility, prior authorizations, and other issues; correct and rebill claims as necessary.
• Demonstrate advanced knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, third-party insurances) and cross-train on other pharmacy department functions.
• Serve as subject-matter expert and resource for pharmacy information systems and workflow, including processing prior authorizations, resolving rejections, producing reports, and completing billing functions accurately and on time.
• Consistently exceed established accuracy and productivity levels.
• Follow all applicable government regulations, including HIPAA.
• Collaborate with team members to meet the pharmacy’s service goals.
• Perform other essential functions and duties as assigned.

Requirements

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements; National Certification (PTCB) preferred and may be required.
• 3+ years of related experience, including a minimum of 1 year at the Billing Specialist II level.
• Advanced computer skills; experience with pharmacy information systems required.
• Strong understanding of PBMs, prescription adjudication, prior authorization, brand vs. generic drugs, OTC products, and pharmacy workflow.

Skills

• Intrinsic drive to excel and alignment with company values (work ethic/integrity).
• Ability to build relationships and serve as a “trusted advisor.”
• Strategic thinking and efficient time management.
• Analytical problem-solving at the functional level.
• Team-oriented collaboration.
• Ability to work independently, meet deadlines, and manage multiple tasks in a fast-paced environment.
• Exceptional attention to detail and accuracy.
• Quality-focused mindset with motivation to identify and inquire about inaccuracies.

Benefits

• Competitive pay and 401(k) with company match.
• Medical, dental, and vision coverage (for full-time employees working 30+ hours/week).
• Health Savings Accounts and Flexible Spending Accounts.
• Company-paid Basic Life, Accidental Death & Dismemberment, and Long-Term Disability insurance; optional Short-Term Disability.
• Voluntary Employee and Dependent Life, Accident, and Critical Illness insurance.
• Dependent Care Flexible Spending Accounts.
• Employee Assistance Program (EAP) and Guardian Angels (employee assistance fund).
• Paid holidays, sick days, and generous vacation benefits based on years of service.

Work environment

Low-to-moderate noise level in an office setting. The role requires effective interaction with others, conflict management, and the ability to handle stressful situations and deadlines. Desk work in an office environment with flexible hours.