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Guardian Pharmacy · 1 day ago

Pharmacy Technician Billing Specialist

Jacksonville, FL

Full-time

Onsite

Entry Level

1+ years exp

Guardian Pharmacy of Jacksonville is one of the nation’s largest providers of long-term care pharmacy services, offering a unique opportunity for career growth. The Pharmacy Technician Billing Specialist will be responsible for processing customer bills and insurance claims while providing excellent customer service to patients, caregivers, and insurance carriers.

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

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

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 as necessary, 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

Qualification

Pharmacy Technician LicensePharmacy Information SystemsInsurance Claims ProcessingCustomer ServiceStrategyPlanningAttention to DetailProblem SolvingTeam OrientedWork Ethic