Pharmacy Billing Specialist

Orlando, Florida, United States of America

10am-6:30pm;
Department hours are 7am-7:00pm. If there is a coverage issue, the above hours might alter. Also at the end of each billing cycle, some extended hours and occasional weekend coverage may be required.

This role will be performed onsite at a closed‑door pharmacy in Orlando, FL. All patient interactions will be over the phone.

• Comprehensive training provided side by side with the training team.
• Must be comfortable working in a high‑volume environment.
• Must be registered with the Florida Pharmacy Board Registry.

• Research patient eligibility and coverage with insurance providers, including private individuals and government entities; reverify benefit coverage criteria as needed for claims follow‑up; accurately enter and 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 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 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.

• 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 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 a 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 (pharmacy specific).

• 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 strict deadlines.
• Quality‑minded; motivated to seek out errors and inquire about inaccuracies.

• The noise level in the work environment is usually low to moderate.
• Must be able to interact…