Pharmacy Billing Specialist

Job Overview

Position:
Courier (Billing & Pharmacy Services Specialist)

Schedule:

Monday-Friday 8:30am-5:30pm

Location:

Crestview, Florida, United States of America

• Process customer bills and insurance claims accurately and timely, including all 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, and reverify benefit coverage criteria as needed.
• Enter and update patient/insurance information in the billing system.
• Maintain and audit patient files and documentation to defend third‑party audits and ensure payer and company compliance.
• Assist with billing inquiries via phone or electronic communications; research and resolve billing issues regarding insurance eligibility, coverage, and related benefits.
• Run Medicare plan comparisons during open enrollment and special enrollment periods, reviewing patient profiles, drug regimens, and insurance coverage to evaluate options to save residents 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 make payment arrangements.
• Organize requested audit documentation in a timely manner.
• Perform prescription claims adjudication, communicating with insurance companies regarding rejected claims, eligibility, prior authorizations, or other issues; make corrections and rebill as necessary.
• Develop knowledge of pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans, and Third‑Party Insurances).
• Develop proficiency in pharmacy information systems to meet operational needs and regulatory requirements, including prior authorizations, resolving rejections, producing reports, and completing billing functions.
• Rotate through other departments to gain functional knowledge of other workflows.
• Follow all applicable government regulations, including HIPAA.
• Collaborate with team members to meet pharmacy service goals.

• Work ethic and integrity, intrinsic drive to excel with values aligned to company philosophy.
• Relational: ability to build relationships with business unit management and act as a trusted advisor.
• Strategic and planning: ability to think ahead, plan, and manage time efficiently.
• Problem solving: ability to analyze causes and solve problems at the 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.

• 1+ year of related experience.
• Advanced computer skills; pharmacy information system experience preferred.
• Ability to work independently and meet deadlines.
• Great attention to detail and accuracy.
• Ability to excel in a fast‑paced, team‑oriented environment, managing multiple tasks simultaneously while meeting strict deadlines.
• Quality minded; motivated to identify errors and request clarifications.

• Noise level usually low to moderate.
• Requires effective interaction with others in an office environment, conflict management, and handling stressful situations and deadlines.
• Desk work in office environment.
• Flexible hours may be required.

Guardian provides a comprehensive Total Rewards package that supports the core value of treating others as you would like to be treated.

• Competitive pay.
• 401(k) with company match.

• Medical, Dental, and Vision.
• Health Savings Accounts and Flexible Spending Accounts.
• Company‑paid Basic Life and Accidental Death & Dismemberment.
• Company‑paid Long‑Term Disability and optional Short‑Term Disability.
• Voluntary Employee and Dependent Life, Accident, and Critical Illness.
• Dependent Care Flexible Spending Accounts.

• Employee Assistance Program (EAP).
• Guardian Angels (Employee assistance fund).

• Paid holidays and sick days.
• Generous vacation benefits based on years of service.

Our clients require pharmacy services that aren’t “cookie‑cutter.” Each Guardian pharmacy is locally operated and empowered with the autonomy to tailor services to meet client needs. Corporate support offices based in Atlanta, Ga., provide human resources, business intelligence, legal, and marketing services to promote the success of each location. We encourage innovative thinking, intellectual curiosity, and diverse viewpoints to stay competitive.

We are dedicated to fostering and advancing a diverse and inclusive workforce. Join us to discover what your best work truly looks like.