Billing Specialist

Candidate must be local to San Diego, CA!

WHO WE ARE
At Polaris Pharmacy Services, we're more than a pharmacy - we're a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we're raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.

Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job - we provide competitive pay, robust benefits, and genuine opportunities for career advancement.

If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.

JOB SUMMARY:

The Billing Specialist is responsible for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements.

DUTIES/RESPONSIBILITIES:

• Process third-party billing, claim resolution, and adjudication
• Manage FFS and PPS billing
• Conduct census balancing and payor verification
• Verify insurance and Medicaid coverage
• Knowledge of Dual Coverage, MCR D, and Commercial Plans pertaining to Long Term Care
• Assist with all customer billing inquiries in a courteous and professional manner
• Enter fees and charges in Framework LTC
• Prepare daily, weekly, and monthly pre-bills and account audits
• Prepare daily, weekly, and monthly reports
• Create statements and EOM summaries
• Understand and work with residents on account balances
• Follow all applicable government regulations including HIPAA
• Other duties as deemed necessary by Billing Manager

QUALIFICATIONS/COMPETENCIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

REQUIRED SKILLS/ABILITIES:

• Able to read, write, speak, and understand the English language
• Able to work in a fast-paced environment
• Basic computer knowledge skills required
• Basic math and analytical skills
• Proficient in Microsoft Word, Excel, and Outlook required
• Good organization/Attention to detail
• Able to work at a moderate speed
• Reliable
• Problem solver
• Able to work various shifts and days
• Adaptability to an ever-changing environment

EDUCATION and/or EXPERIENCE:

• High School diploma or equivalent required
• Two (2) years' pharmacy billing experience required (long-term care preferred)
• Framework LTC & General computer knowledge & 10-key Number Entry preferred
• Knowledge of Sage preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
• May be necessary to work extended hours as needed
• May lift and/or move up to 30 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

• Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
• Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
• Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.

BENEFITS for full time Employees

• Medical, Dental, and Vision insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Company Paid Life insurance
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program