Compliance Specialist - Medical Billing

Job Description

Job Description

Who We Are  
Advantage is redefining what it means to be a pharmacy for people with serious behavioral health conditions. We specialize in serving patients with schizophrenia, bipolar disorder, substance use disorder, and related challenges—patients who are often overlooked by traditional healthcare systems. We provide advanced pharmacy services and wraparound care that ensure patients can access and stay on complex medications. We offer in-home and community-based injection support, help patients navigate insurance and prior authorizations, and work closely with providers to overcome barriers to treatment. By strengthening connections between patients, care teams, and support systems, we make it possible for people living with behavioral health challenges to achieve stability and long-term success. 

Job Overview: 

The Compliance & Billing Specialist supports the organization's pharmacy compliance, licensing, credentialing, and reimbursement functions by ensuring regulatory requirements, payer expectations, and internal standards are accurately executed and maintained. This role serves as a key operational partner to Compliance, Pharmacy Operations, Revenue Cycle, and Credentialing teams to support licensing activities, billing compliance, audit readiness, reimbursement requirements, and ongoing regulatory compliance.

The ideal candidate combines strong administrative discipline with knowledge of pharmacy operations, licensing regulations, healthcare reimbursement, medical billing, pharmacy claims processing, and regulatory documentation.

Benefits:

• Vacation and Sick Pay 

• Day shift schedule 

• Nights and Weekends Off 

• Medical/Vision/Drug Insurance 

• Dental Insurance 

• 401k Plan with Matching up to 5% 

• Tuition Reimbursement Program 

• Referral Bonus Program 

• Life Insurance 

• Wellness Resources 

• 9 Holidays and 2 Floating Holidays based on tenure 

Essential Responsibilities

Pharmacy Licensing & Regulatory Compliance

· Assist with all phases of pharmacy licensing and registration activities, including applications, renewals, amendments, and ownership changes.

· Maintain accurate licensing records, databases, expiration tracking, and supporting documentation.

· Coordinate submissions with Boards of Pharmacy, DEA, state agencies, Medicare, Medicaid, and other regulatory bodies.

· Monitor regulatory deadlines and ensure timely renewals and reporting obligations.

· Conduct research on evolving state and federal pharmacy regulations.

· Maintain audit-ready licensing documentation and records.

Billing Compliance & Reimbursement Support

· Research, support, and monitor pharmacy and medical billing processes (e.g., claims submission, reimbursement, billing documentation) for compliance with payer, contractual, and regulatory requirements.

· Assist with internal and third-party audits of pharmacy claims, authorizations, billing records, and supporting clinical documentation.

· Help identify reimbursement risks, denials trends, and compliance concerns.

· Monitor adherence to payer policies, reimbursement guidelines, and contract requirements.

· Assist with implementation of billing compliance controls and corrective action plans.

Audit Readiness

· Assist with internal audits and monitoring activities related to licensing, billing, reimbursement, credentialing, and compliance.

· Gather and organize documentation for regulatory reviews, payer audits, accreditation surveys, and compliance assessments.

· Track corrective actions and support remediation efforts.

· Maintain compliance evidence repositories and audit logs.

Policy, Documentation & Training Support

· Assist in developing and maintaining policies, procedures, workflows, and job aids.

· Support compliance education and training initiatives.

· Ensure operational changes resulting from regulatory or payer updates are communicated and documented.

· Maintain accurate records of compliance activities and training completion.

Cross-Functional Collaboration

· Partner with Pharmacy Operations, Revenue Cycle, Credentialing, Quality, and Compliance teams.

· Serve as a resource regarding licensing requirements, billing compliance standards, and reimbursement guidelines.

· Escalate compliance concerns, audit findings, or identified risks to leadership.

· Support special projects related to compliance program development and operational readiness.

Reporting & Data Management

· Maintain compliance dashboards, trackers, and reporting metrics.

· Monitor license expiration dates, audit findings, corrective action status, and reimbursement trends.

· Generate reports to support compliance monitoring and leadership reviews.

· Ensure data accuracy within licensing and compliance systems.

Required Skills: 

• · Knowledge of healthcare and pharmacy regulatory requirements.

  · Understanding of medical billing, pharmacy billing, claims processing, prior authorization, and reimbursement practices highly preferred.

  · Strong attention to detail and document management skills.

  · Excellent organizational and project coordination abilities.

  · Strong analytical and problem-solving skills.

  · Ability to research and summarize regulatory requirements and operational procedures.

  · Effective written and verbal communication.

  · Ability to manage multiple priorities and deadlines.

  · Advanced Microsoft Excel, Word, Outlook, and reporting skills.

Education and Experience: 

• Required:

  • · Associate's degree in Healthcare Administration, Business Administration, Compliance, Pharmacy Technology, or related field.

    · 3+ years of healthcare, pharmacy, compliance, licensing, credentialing, medical billing, or reimbursement experience.

    Preferred:

    · Bachelor's degree in Healthcare Administration, Business, Public Health, Compliance, or related field.

    · Certified Pharmacy Technician (CPhT) certification.

    · Experience in specialty pharmacy, behavioral health pharmacy, or multi-state pharmacy operations.

    · Experience supporting audits, licensing programs, or pharmacy reimbursement activities.

 

Working Conditions: 

• Full-time, typically requiring 40+ hours per week 

• Work is performed in an office setting 

• Prolonged periods sitting at a desk and working on a computer 

• Must be able to lift up to 15 pounds at times 

• Able to travel as needed 

Why Join Us  
At Advantage, you’ll be part of a mission-driven organization that blends clinical expertise with compassion. We believe in meeting patients where they are—whether physically, emotionally, or financially—and providing care that restores stability and dignity. 

If you want your work to directly improve lives, strengthen healthcare systems, and bring hope to people and families facing behavioral health challenges, Advantage is the place to make an impact. 

Advantage Healthcare Services is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.