Guardian Pharmacy
Overview
Billing Specialist role at Guardian Pharmacy in Indianapolis, Indiana. This position focuses on processing customer bills and insurance claims accurately and in a timely manner, and providing excellent customer service to patients, caregivers, medical providers, and insurance carriers. Responsibilities
Process customer bills and insurance claims accurately and timely, including daily and month-end billing functions, procedures, and reporting. Provide excellent customer service to patients, caregivers, medical providers, and insurance carriers. Research and establish patient eligibility coverage with insurance providers, reverify benefit coverage criteria as needed for claims follow up, and accurately enter/update patient and insurance information into the billing system. Maintain and audit patient files and documentation to defend third-party audits and ensure payer and company compliance; accurately enter patient information into the pharmacy system. Respond to billing inquiries via phone or electronic communications and research and resolve patient billing issues related to insurance eligibility, coverage, and benefits. Assist residents or responsible parties by running Medicare plan comparisons during open enrollment and special enrollment periods; review patient profiles, drug regimens, and insurance coverage to evaluate options to save resident money. Handle daily census, admissions, discharges, and room changes for assigned facilities. Process patient payments, returns, and credits; transmit credit card payments as needed. Pursue payment from delinquent accounts and arrange payment terms as necessary. Research, identify, and organize requested audit documentation in a timely manner. Perform prescription claims adjudication, communicate with insurance companies regarding rejections or prior authorizations, make corrections, and rebill as needed. Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, and third-party insurances) and utilize pharmacy information systems to meet operational and regulatory needs. Process prior authorizations, resolve rejections, generate reports, and complete billing functions using pharmacy systems. Rotate through other departments to gain knowledge of interdepartmental workflows. Follow applicable government regulations including HIPAA; work as a collaborative team member to meet service goals. Other essential functions and duties may be assigned as needed. Qualifications
High School Diploma or GED required. Pharmacy Technician license/certification/registration per state requirements; National Certification (PTCB) preferred or may be required. 1+ years of related experience. Advanced computer skills; pharmacy information system experience preferred. Ability to work independently and meet deadlines; strong attention to detail and accuracy. Ability to work in a fast-paced, team-oriented environment on multiple tasks while adhering to deadlines; quality minded with a proactive approach to identify and resolve errors. Work Environment
The work environment is typically low to moderate noise. Require effective interaction with others in an office environment; capable of managing conflict and handling stressful situations and deadlines. Desk-based work in an office environment; ability to work flexible hours. What We Offer
Competitive pay 401(k) with company match Medical, Dental, and Vision insurance Health Savings Accounts and Flexible Spending Accounts Company-paid Basic Life and AD&D; Company-paid long-term disability; optional short-term disability Voluntary life, accidental death & dismemberment, and critical illness insurance Paid holidays and paid time off; generous vacation benefits based on years of service Employee Assistance Program (EAP) and other wellbeing benefits Additional
Guardian is committed to fostering and advancing a diverse and inclusive workforce.
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Billing Specialist role at Guardian Pharmacy in Indianapolis, Indiana. This position focuses on processing customer bills and insurance claims accurately and in a timely manner, and providing excellent customer service to patients, caregivers, medical providers, and insurance carriers. Responsibilities
Process customer bills and insurance claims accurately and timely, including daily and month-end billing functions, procedures, and reporting. Provide excellent customer service to patients, caregivers, medical providers, and insurance carriers. Research and establish patient eligibility coverage with insurance providers, reverify benefit coverage criteria as needed for claims follow up, and accurately enter/update patient and insurance information into the billing system. Maintain and audit patient files and documentation to defend third-party audits and ensure payer and company compliance; accurately enter patient information into the pharmacy system. Respond to billing inquiries via phone or electronic communications and research and resolve patient billing issues related to insurance eligibility, coverage, and benefits. Assist residents or responsible parties by running Medicare plan comparisons during open enrollment and special enrollment periods; review patient profiles, drug regimens, and insurance coverage to evaluate options to save resident money. Handle daily census, admissions, discharges, and room changes for assigned facilities. Process patient payments, returns, and credits; transmit credit card payments as needed. Pursue payment from delinquent accounts and arrange payment terms as necessary. Research, identify, and organize requested audit documentation in a timely manner. Perform prescription claims adjudication, communicate with insurance companies regarding rejections or prior authorizations, make corrections, and rebill as needed. Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs, and third-party insurances) and utilize pharmacy information systems to meet operational and regulatory needs. Process prior authorizations, resolve rejections, generate reports, and complete billing functions using pharmacy systems. Rotate through other departments to gain knowledge of interdepartmental workflows. Follow applicable government regulations including HIPAA; work as a collaborative team member to meet service goals. Other essential functions and duties may be assigned as needed. Qualifications
High School Diploma or GED required. Pharmacy Technician license/certification/registration per state requirements; National Certification (PTCB) preferred or may be required. 1+ years of related experience. Advanced computer skills; pharmacy information system experience preferred. Ability to work independently and meet deadlines; strong attention to detail and accuracy. Ability to work in a fast-paced, team-oriented environment on multiple tasks while adhering to deadlines; quality minded with a proactive approach to identify and resolve errors. Work Environment
The work environment is typically low to moderate noise. Require effective interaction with others in an office environment; capable of managing conflict and handling stressful situations and deadlines. Desk-based work in an office environment; ability to work flexible hours. What We Offer
Competitive pay 401(k) with company match Medical, Dental, and Vision insurance Health Savings Accounts and Flexible Spending Accounts Company-paid Basic Life and AD&D; Company-paid long-term disability; optional short-term disability Voluntary life, accidental death & dismemberment, and critical illness insurance Paid holidays and paid time off; generous vacation benefits based on years of service Employee Assistance Program (EAP) and other wellbeing benefits Additional
Guardian is committed to fostering and advancing a diverse and inclusive workforce.
#J-18808-Ljbffr