Billing Specialist II

Billing Specialist II – Guardian Pharmacy

Mountlake Terrace, Washington, United States of America.

Compensation: $26 - $30 per hour.

Extraordinary Care. Extraordinary Careers.

With one of the nation’s largest, most innovative long‑term care pharmacy services providers, there is no limit to the growth of your career. Our unique business model combines the personal touch of locally operated pharmacies with the robust support of our Atlanta‑based corporate team, ensuring best‑in‑class pharmacy care for our customers.

We are reimagining medication management and transforming care. Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. With a comprehensive suite of tech‑enabled pharmacy services and a dedicated team of professionals committed to enriching the lives of those we serve, we are redefining how pharmacy care is delivered.

Responsible for processing customer bills and insurance claims accurately and timely, including 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—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. Use working knowledge to troubleshoot and resolve customer service issues.
• 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 residents 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.
• Demonstrate knowledge and understanding of pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third‑Party Insurances) and working/functional knowledge of other pharmacy departmental functions.
• Use pharmacy information 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 pharmacy’s service goals.
• Other essential functions and duties may be assigned as needed.

• Work Ethic/Integrity – intrinsic drive to excel and alignment with company values.
• Relationship Building – ability to build relationships with business unit management and become a trusted advisor.
• Strategy 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 Orientation – ability to work effectively and collaboratively with all team members.

• High…