Billing Specialist 1
Company: Guardian PHarmacy, LLC
Posted on: September 16, 2023
Birmingham, Alabama, United States of AmericaGuardian Pharmacy
of Birmingham is part of the Guardian Pharmacy Services network and
prides itself on its customer service. Each team member plays an
integral part in the success of the pharmacy.
Responsible for processing customer bills and insurance claims in
an accurate and timely manner. This includes assisting with all
daily and month-end billing functions, procedures and reporting.
Provides excellent customer service to patients, caregivers,
medical providers and insurance carriers.SCHEDULE: MONDAY-FRIDAY
8AM-4:30PMATTRIBUTES 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
- Problem Solving - ability to analyze causes and solve problems
at functional level.
- Team Oriented - ability to work effectively and collaboratively
with all team members.
ESSENTIAL JOB FUNCTIONS (include the following):
- 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
- 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
- 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
- Work as a collaborative team member to meet the service goals
of the pharmacy.
- Other essential functions and duties may be assigned as
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 (pharmacy specific).
SKILLS AND QUALIFICATIONS:
- 1+ years of related experience
- Advanced computer skills; pharmacy information system
- 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
- Quality minded; motivated to seek out errors and inquire about
WORK ENVIRONMENT: The work environment characteristics described
here are representative of those an employee encounters while
performing the job.
- The noise level in the work environment is usually low to
- Due to the collaborative nature of the business and the need to
service customers, the employee must be able to interact
effectively with others in an office environment, manage conflict,
and handle stressful situations and deadlines. -
- Requires desk work in office environment.
- Ability to work flexible hours.Full-Time employees working 30+
hours per week are eligible to enroll in our comprehensive benefits
package, which includes medical, dental, vision, short and
long-term disability, life and supplemental life insurance, and
PTO.All employees -are eligible to enroll in our company matched
Keywords: Guardian PHarmacy, LLC, Birmingham , Billing Specialist 1, Accounting, Auditing , Birmingham, Alabama
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