Pharmacy Billing Specialist

Pharmacy Billing Specialist role at Guardian Pharmacy – North Port, Florida

Guardian Pharmacy of Southwest Florida, a member of the Guardian family of pharmacies, has an exciting opportunity to join our rapidly growing team in North Port, Florida. This on-site role is at a closed-door pharmacy and involves all patient interactions being conducted over the phone. Comprehensive training will be provided alongside the training team. The schedule is Tuesday–Friday 10 : 30 AM – 7 : 00 PM and Saturday 9 : 00 AM – 5 : 30 PM.

We offer full-time benefits including health, vision, dental, and matching 401(k).

Overview

Responsible for processing customer bills and insurance claims in an accurate and timely manner, including assisting with daily and month-end billing functions, procedures and reporting. Provide excellent customer service to patients, caregivers, medical providers and insurance carriers.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers, including private individuals and government entities; reverify benefit coverage criteria as needed for claims follow up; accurately enter and / or update patient / insurance information into the billing system.
• Maintain and audit patient files and documentation necessary to defend third-party audits and ensure payer and company compliance; accurately enter patient information into the pharmacy system.
• Respond to billing inquiries via phone or electronic methods; research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits.
• Provide guidance and support to residents or responsible parties by running Medicare plan comparisons during open enrollment and special enrollment periods; review patient profiles, drug regimens and insurance coverage to evaluate options to save money.
• Complete daily census, admit, discharge, and room changes for assigned facilities; process patient payments, returns and credits; transmit individual credit card payments as needed.
• Pursue payment from delinquent accounts and arrange payment plans as necessary.
• Research and organize requested audit documentation in a timely manner.
• Perform prescription claims adjudication, including communication with insurance companies regarding rejections, eligibility, prior authorizations or other issues; make corrections and rebill as needed.
• Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs and Third-Party Insurances) and proficiency in pharmacy information systems to meet operational and regulatory needs.
• Rotate through other departments to gain cross-functional knowledge of workflows. Adhere to HIPAA and work as a collaborative team member to meet service goals.
• Other essential functions may be assigned as needed.

Qualifications

Education and / or Certifications

Skills and Experience

Work Environment

What We Offer

The Guardian Difference

Guardian supports locally operated pharmacies with corporate services in areas like HR, BI, legal, and marketing to promote success. We value innovative thinking, intellectual curiosity, and diverse viewpoints to stay competitive in healthcare. Guardian is committed to fostering an inclusive workforce.

Join us to discover what your best work truly looks like.

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