Medical Biller

Job Description

Job Description

We are seeking an experienced and detail-oriented Medical Biller to support billing operations for a pharmacy specializing in high-cost specialty medications, with additional exposure to retail pharmacy billing. This role is critical to revenue integrity, compliance, and payer coordination.

The ideal candidate is organized, analytical, and experienced with pharmacy claims, third-party payers, and reimbursement workflows.

Key Responsibilities

Submit, review, and reconcile pharmacy claims for specialty and retail medications

Process claims through commercial, Medicare, Medicaid, and other third-party payers

Identify, research, and resolve rejected or denied claims

Manage prior authorization follow-up, appeals, and payer correspondence

Ensure accurate billing in compliance with payer contracts and regulatory requirements

Post payments, adjustments, and explanations of benefits (EOBs)

Communicate with internal staff, payers, and occasionally patients regarding billing matters

Maintain organized billing records and documentation

Assist with audits, reporting, and compliance reviews as needed

Perform other administrative or billing-related duties as assigned

Required Qualifications

Prior experience in pharmacy billing, medical billing, or healthcare reimbursement

Knowledge of insurance claim processes and payer requirements

Strong attention to detail and organizational skills

Ability to manage multiple claims and deadlines accurately

Professional communication skills

Preferred Qualifications

Experience with specialty pharmacy billing

Familiarity with high-cost medications and complex reimbursement models

Knowledge of Medicare, Medicaid, and commercial pharmacy benefit plans

Experience working denials, appeals, and coordination of benefits