Pharmacy Billing Specialist - On-Site

Brunswick, Maine, United States of America Guardian Pharmacy of Maine offers an exciting opportunity to join our rapidly growing team in Brunswick, Maine. Schedule Must be flexible between the hours of 6 am – 7 pm. Pay range $22 per hour. This position is 100% on‑site. Job Summary 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, and providing excellent customer service to patients, caregivers, medical providers, and insurance carriers. Attributes Required Work Ethic/Integrity – intrinsic drive to excel with values in line with company philosophy Relational – ability to build relationships with business unit management and become a trusted advisor Strategy and Planning – ability to think ahead, plan, and manage time efficiently Problem Solving – ability to analyze causes and solve problems at the functional level Team Oriented – ability to work effectively and collaboratively with all team members Essential Job Functions Research and establish patient eligibility coverage with insurance providers; reverify benefit coverage criteria as needed; accurately enter and 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 residents or responsible parties 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; communicate with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues; make corrections as needed and rebill claims as necessary. Develop knowledge and understanding of 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; use pharmacy systems to process prior authorizations, resolve rejections, produce various reports, and complete billing functions. Rotate through other departments to gain 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. 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. Skills and Qualifications 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, managing multiple tasks simultaneously while adhering to strict deadlines. Quality‑minded; motivated to seek out errors and inquire about inaccuracies. Work Environment Noise level is usually low to moderate. Must interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. Requires desk work in an office environment. Ability to work flexible hours. Benefits Competitive pay. 401(k) with company match. Medical, dental, and vision (for full‑time employees working 30+ hours/week). 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 benefits. 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. Guardian Pharmacy of Maine is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, protected veteran status, or disability. #J-18808-Ljbffr Guardian Pharmacy, LLC