Billing Specialist

Our client is seeking a detail-oriented and motivated Pharmacy Data Entry / Billing Specialist to join its team.

The Billing Specialist will play an important role in maintaining accurate billing records, researching insurance discrepancies, resolving rejected claims, and supporting the daily financial operations of the pharmacy.

The successful candidate will work alongside an experienced billing team in a collaborative environment where accuracy, efficiency, and customer service are highly valued.

This is an excellent opportunity for an individual with pharmacy billing, medical billing, insurance claims, or healthcare revenue cycle experience who is looking to join a stable organization with long-term growth potential.

Pharmacy Billing Specialist Responsibilities:
Pharmacy Billing & Claims Resolution
Prepare, process, and submit billing for long-term care pharmacy residents.
Process claims involving Medicare Part D, Medicaid, private insurance, hospice, and other third-party payers.
Investigate and resolve rejected claims, insurance denials, payment discrepancies, and underpayments.
Research billing issues related to medication coverage, refill limitations, insurance eligibility, and payer requirements.
Monitor daily billing queues and work through outstanding claim errors efficiently.
Review billing transactions to ensure accurate payer information and appropriate reimbursement.
Assist with high-volume billing corrections during month-end processing.

Data Entry & Account Maintenance
Maintain accurate resident billing information, including admissions, discharges, insurance changes, and payer updates.
Enter and update insurance information within pharmacy billing systems.
Process billing adjustments, payments, credits, and account corrections.
Review facility census information to ensure accurate billing classifications.
Complete billing comparisons to identify discrepancies between Medicare, private-pay, hospice, and other payer classifications.
Maintain organized billing records and supporting documentation.
Assist with cycle billing, daily billing, and ancillary charges.

Accounts Receivable & Reconciliation
Monitor outstanding accounts receivable and assist with collection efforts.
Research unpaid balances and follow up on outstanding claims.
Support month-end billing reconciliation and reporting.
Assist with identifying discrepancies between billed amounts and payments received.
Prepare and maintain accurate documentation for billing reviews and audits.

Communication & Team Support
Communicate with insurance providers, long-term care facilities, and internal pharmacy personnel to resolve billing issues.
Collaborate with facility Business Office Managers and Directors of Nursing to obtain required documentation.
Respond to billing-related telephone calls, emails, and customer inquiries.
Support other billing team members during periods of increased workload.
Maintain confidentiality and ensure compliance with applicable billing and privacy requirements.

Pharmacy Billing Specialist Qualifications:
Previous experience in healthcare billing, pharmacy billing, medical billing, insurance claims processing, or a related administrative role.
Strong understanding of insurance verification, claim processing, or reimbursement procedures.
Excellent attention to detail and accuracy in data entry.
Strong problem-solving and analytical skills.
Proficiency with Microsoft Office, particularly Excel.
Ability to organize, sort, filter, and review spreadsheet data.
Excellent verbal and written communication skills.
Strong customer service skills and ability to work with internal and external contacts.
Ability to manage high-volume workflows and meet deadlines.
Ability to work independently while contributing to a collaborative team environment.

Preferred Qualifications
Experience in long-term care pharmacy billing or healthcare revenue cycle operations.
Knowledge of Medicare Part D, Medicaid, hospice, and third-party payer requirements.
Experience with QS-1 pharmacy management software.
Familiarity with DocuTrack or comparable pharmacy documentation systems.
Experience researching rejected claims, billing errors, and insurance discrepancies.
Experience with month-end billing reconciliation and accounts receivable.
Understanding of long-term care resident admissions, discharges, and payer changes.

Benefits:
Medical, dental, and vision insurance.
Short-term and long-term disability insurance.
Life insurance.
401(k) retirement plan with a company match.
Health SavMings Account options.
Paid time off and paid holidays.
Generous vacation accrual.