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Guardian Pharmacy · 1 month ago

Billing Specialist II

Mountlake Terrace, WA

Full-time

Onsite

Entry, Mid Level

$26/hr - $30/hr

2+ years exp

Guardian Pharmacy is one of the nation’s largest and most innovative long-term care pharmacy services providers, dedicated to delivering customized medication management solutions. The Billing Specialist II role involves processing customer bills and insurance claims, providing excellent customer service, and maintaining compliance with pharmacy billing requirements.

Assisted LivingElder CareHealth CareNursing and Residential Care

Responsibilities

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 enters and/or updates patient/insurance information into billing system

Maintain and continually 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. Uses working knowledge to troubleshoot and resolve customer service issues

Provide guidance and support to resident or responsible party 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 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

Through prior experience and cross training, demonstrate knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions

Exercise 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 as necessary, and complete billing functions in a timely manner and with a high degree of accuracy

Consistently meet pharmacy's established accuracy and productivity levels

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

Qualification

Pharmacy Technician certificationBilling experiencePharmacy information systemsCustomer serviceAttention to detailStrategyPlanningProblem solvingTeam orientedWork ethic

Required

Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy

Relational – ability to build relationships with business unit management and become “trusted advisor.”

Strategy and Planning – ability to think ahead, plan and manage time efficiently

Problem Solving – ability to analyze causes and solve problems at functional level

Team Oriented – ability to work effectively and collaboratively with all team members

High School Diploma or GED required

Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific)

2 + years related experience including a minimum of 6 months billing experience in long term care or retail setting

Advanced computer skills; pharmacy information system experience required

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