Pharmacy Technician - Billing Specialist

Gainesville, Virginia, United States of America

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.

Monday – Friday open availability required between 7:30 am and 8 pm. Rotating weekend schedule.

• Work Ethic/Integrity – intrinsic drive to excel aligned with company philosophy
• Relational – ability to build relationships with business unit management and serve as a "trusted advisor"
• Strategy and Planning – think ahead, plan, and manage time efficiently
• Problem Solving – analyze causes and solve problems at the functional level
• Team Oriented – work effectively and collaboratively with all team members

• 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 enter and/or update patient/insurance information into the 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 residents or responsible parties 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 a 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, and Third‑Party Insurances).
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements, including processing prior authorizations, resolving rejections, producing reports and completing 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.

• High School Diploma or GED required.
• Pharmacy Technician license/certification/registration per state requirements;
  National Certification preferred (PTCB) may be required.

• 1+ years of related experience.
• Advanced computer skills; pharmacy information system experience preferred.
• 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…