Billing Specialist

If you are seeking a career move in the pharmacy sector and want to be part of a team that puts employees first and cares more about culture and great service than profit, look no further. Guardian Pharmacy of Minneapolis is looking for you!

Building upon the success of Guardian Pharmacy of MN in Sauk Rapids, Guardian Pharmacy of Minneapolis opened in August 2021 in the southwest Twin Cities metro. We are looking for talented and caring individuals who love the business of pharmacy and want to use their talents and skills to make a difference in the lives of the vulnerable population we serve.

We are committed to:

• Providing the best service in the industry to our partner facilities
• Focusing on the development of you as a team member and helping you advance your career goals
• Building a collaborative culture that values each person’s unique voice and insights
• Listening to our customers and collaborating to find solutions to the challenges they face
• Sharing the work – everyone at Guardian, from the president to front-line team members, has a responsibility to jump in and support one another, every day

You are committed to:

• Embracing new opportunities and challenges
• Providing extraordinary customer service
• Remaining focused on your work and on making a difference to our clients
• Learning and adapting to the rapidly changing technology that drives our business

Schedule: Monday, Wednesday, Friday 9am-5pm Tuesday, Thursday 8am-4pm

One closing shift (6:30pm) per week and the possibility of a weekend (maybe one every 6-7 weeks)

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.

ATTRIBUTES REQUIRED:

• 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 “trusted advisor.”
• Strategy and Planning – ability to think ahead, plan and manage time efficiently.
• Problem Solving – ability to analyze causes and solve problems at functional level.
• Team Oriented – ability to work effectively and collaboratively with all team members.

ESSENTIAL JOB FUNCTIONS (include the following):

• 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 enters and/or updates patient/insurance information into 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.
• Research, identify and organize requested audit documentation in 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 (PDPs) and Third-Party Insurances)
• Develop proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete 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.

EDUCATION AND/OR CERTIFICATIONS:

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

SKILLS AND QUALIFICATIONS:

• 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.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the job.

• The noise level in the work environment is usually low to moderate.
• Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.
• Requires desk work in office environment.
• Ability to work flexible hours.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• Weekend availability

Work Location: In person