Pharmacy Billing Specialist

Schedule Monday - Friday 8:30 am – 5:30 pm Pay Range $23 – $24 per hour Job Location Brighton, Michigan, United States of America Responsibilities Responsible for processing customer bills and insurance claims accurately and in a 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. Essential Job Functions 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 or update patient/insurance information into the billing system. Maintain and audit patient files and corresponding documentation necessary to defend third‑party audits and ensure payer and company compliance; accurately enter patient information into the pharmacy system. 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 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. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports, and complete billing functions. 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. Attributes Required Work ethics and 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. Education and Certifications High School Diploma or GED required. Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB). CPT License preferred. 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 working on multiple tasks simultaneously, while adhering to strict deadlines. Quality‑minded; motivated to seek out errors and inquire about inaccuracies. Work Environment The noise level is usually low to moderate. Must interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. Desk work in an office environment. Ability to work flexible hours. 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 insurance 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 #J-18808-Ljbffr Guardian Pharmacy