[Hiring] Pharmacy Technician - Billing Specialist @Guardian Pharmacy

Role Description

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

• Research 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 enter and/or update patient/insurance information into the billing system.
• Maintain and continually audit patient files and corresponding documentation necessary to defend third-party audits and ensure payer and company compliance.
• 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.
• Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods.
• Proactively review patient profiles, drug regimens, and insurance coverage to evaluate options to save resident money.
• Responsible for completion of daily census, admit, discharge, and room changes for the facilities assigned.
• 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 a 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.
• 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.
• Other essential functions and duties may be assigned as needed.

Qualifications

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

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.

Benefits

• Competitive pay.
• 401(k) with company match.
• Medical, Dental, and Vision (Full-Time employees working 30+ hours/week only).
• 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.
• Voluntary Employee and Dependent Life, Accident, and Critical Illness.
• Dependent Care Flexible Spending Accounts.
• Employee Assistance Program (EAP).
• Guardian Angels (Employee assistance fund).
• Paid holidays and sick days.
• Generous vacation benefits based on years of service.