Guardian Pharmacy
Pharmacy Billing Specialist
role at
Guardian Pharmacy
– North Port, Florida
Guardian Pharmacy of Southwest Florida, a member of the Guardian family of pharmacies, has an exciting opportunity to join our rapidly growing team in North Port, Florida. This on-site role is at a closed-door pharmacy and involves all patient interactions being conducted over the phone. Comprehensive training will be provided alongside the training team. The schedule is Tuesday–Friday 10:30 AM – 7:00 PM and Saturday 9:00 AM – 5:30 PM.
We offer full-time benefits including health, vision, dental, and matching 401(k).
Overview Responsible for processing customer bills and insurance claims in an accurate and timely manner, including assisting with daily and month-end billing functions, procedures and reporting. Provide excellent customer service to patients, caregivers, medical providers and insurance carriers.
Responsibilities
Research and establish patient eligibility coverage with insurance providers, including private individuals and government entities; reverify benefit coverage criteria as needed for claims follow up; accurately enter and/or update patient/insurance information into the billing system.
Maintain and audit patient files and documentation necessary 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 methods; 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; review patient profiles, drug regimens and insurance coverage to evaluate options to save money.
Complete daily census, admit, discharge, and room changes for assigned facilities; process patient payments, returns and credits; transmit individual credit card payments as needed.
Pursue payment from delinquent accounts and arrange payment plans as necessary.
Research and organize requested audit documentation in a timely manner.
Perform prescription claims adjudication, including communication with insurance companies regarding rejections, eligibility, prior authorizations or other issues; make corrections and rebill as needed.
Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs and Third-Party Insurances) and proficiency in pharmacy information systems to meet operational and regulatory needs.
Rotate through other departments to gain cross-functional knowledge of workflows. Adhere to HIPAA and work as a collaborative team member to meet service goals.
Other essential functions may be assigned as needed.
Qualifications 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 Experience
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 excel in a fast-paced, team-oriented environment and manage multiple tasks with strict deadlines.
Quality-minded with a proactive approach to identify and resolve errors.
Work Environment
Typically low to moderate noise level in an office setting.
Collaborative office environment; ability to manage conflict and handle stress and deadlines.
Desk-based work; flexible hours as required.
What We Offer
Comprehensive Total Rewards package; compensation and benefits for full-time roles.
401(k) with company match; medical, dental and vision coverage; Health Savings Accounts and Flexible Spending Accounts.
Company-paid Basic Life and AD&D; Long-Term Disability; voluntary Life, Accident and Critical Illness insurance; Dependent Care FSA.
Employee Assistance Program (EAP) and Guardian Angels program.
Paid holidays, sick days, and generous vacation benefits based on years of service.
The Guardian Difference Guardian supports locally operated pharmacies with corporate services in areas like HR, BI, legal, and marketing to promote success. We value innovative thinking, intellectual curiosity, and diverse viewpoints to stay competitive in healthcare. Guardian is committed to fostering an inclusive workforce.
Join us to discover what your best work truly looks like.
#J-18808-Ljbffr
role at
Guardian Pharmacy
– North Port, Florida
Guardian Pharmacy of Southwest Florida, a member of the Guardian family of pharmacies, has an exciting opportunity to join our rapidly growing team in North Port, Florida. This on-site role is at a closed-door pharmacy and involves all patient interactions being conducted over the phone. Comprehensive training will be provided alongside the training team. The schedule is Tuesday–Friday 10:30 AM – 7:00 PM and Saturday 9:00 AM – 5:30 PM.
We offer full-time benefits including health, vision, dental, and matching 401(k).
Overview Responsible for processing customer bills and insurance claims in an accurate and timely manner, including assisting with daily and month-end billing functions, procedures and reporting. Provide excellent customer service to patients, caregivers, medical providers and insurance carriers.
Responsibilities
Research and establish patient eligibility coverage with insurance providers, including private individuals and government entities; reverify benefit coverage criteria as needed for claims follow up; accurately enter and/or update patient/insurance information into the billing system.
Maintain and audit patient files and documentation necessary 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 methods; 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; review patient profiles, drug regimens and insurance coverage to evaluate options to save money.
Complete daily census, admit, discharge, and room changes for assigned facilities; process patient payments, returns and credits; transmit individual credit card payments as needed.
Pursue payment from delinquent accounts and arrange payment plans as necessary.
Research and organize requested audit documentation in a timely manner.
Perform prescription claims adjudication, including communication with insurance companies regarding rejections, eligibility, prior authorizations or other issues; make corrections and rebill as needed.
Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, PDPs and Third-Party Insurances) and proficiency in pharmacy information systems to meet operational and regulatory needs.
Rotate through other departments to gain cross-functional knowledge of workflows. Adhere to HIPAA and work as a collaborative team member to meet service goals.
Other essential functions may be assigned as needed.
Qualifications 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 Experience
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 excel in a fast-paced, team-oriented environment and manage multiple tasks with strict deadlines.
Quality-minded with a proactive approach to identify and resolve errors.
Work Environment
Typically low to moderate noise level in an office setting.
Collaborative office environment; ability to manage conflict and handle stress and deadlines.
Desk-based work; flexible hours as required.
What We Offer
Comprehensive Total Rewards package; compensation and benefits for full-time roles.
401(k) with company match; medical, dental and vision coverage; Health Savings Accounts and Flexible Spending Accounts.
Company-paid Basic Life and AD&D; Long-Term Disability; voluntary Life, Accident and Critical Illness insurance; Dependent Care FSA.
Employee Assistance Program (EAP) and Guardian Angels program.
Paid holidays, sick days, and generous vacation benefits based on years of service.
The Guardian Difference Guardian supports locally operated pharmacies with corporate services in areas like HR, BI, legal, and marketing to promote success. We value innovative thinking, intellectual curiosity, and diverse viewpoints to stay competitive in healthcare. Guardian is committed to fostering an inclusive workforce.
Join us to discover what your best work truly looks like.
#J-18808-Ljbffr