• Billing Specialist, Adjudication - Kernersville, NC

    Job ID
    2018-3535
    Department
    Billing/Collections
  • Overview

    Southern Pharmacy Services is part of the Guardian Pharmacy Services network and prides itself on its customer service. Each team member plays an integral part in the success of the pharmacy.

     

    Job Objective: 

    Assist in the process of claim adjudication from 3rd party insurances.

     

    Attributes:

    • Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
    • Strategy and Planning – ability to think ahead, plan and manage time efficiently
    • Problem Solving – ability to analyze causes and solve problems at both a strategic and functional level
    • Team Oriented – ability to work effectively and collaboratively with all team members

     

    Responsibilities: 

    • Reprocess rejected claims to 3rd party providers by identifying why the claim was rejected and making any necessary corrections (prior authorization, new ID#, etc.)
    • Complete prior authorization request forms
    • Processing medication change requests, faxing them to facilities, and tracking outcome.
    • Make outgoing calls to insurers, responsible parties and others to follow up on rejected claims and to garner accurate insurance information.
    • Work collaboratively with co-workers to ensure all deadlines for department are met in an efficient manner
    • Assist in the regular billing invoice production process
    • Process nursing home admissions
    • Other essential functions and duties may be assigned as needed

      

    Education: High School Diploma or G.E.D.; Bachelor's Degree (Math, Economics, Statistics, Engineering, Business, Computer Science, or similar) preferred

     

    Requirements: 

    • 1+ years of related experience (advanced degree may substitute for experience)
    • Advanced computer skills; pharmacy operations system experience preferred/required
    • Ability to work independently and deliver to deadlines
    • Ability to solve problems with minimal direction
    • 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 when something appears inaccurate

     

    Flexible Schedule Required: 

    8-hour shift

    Hours of operation are subject to change based on the needs of the pharmacy

     

    Full-Time employees working 30+ hours per week are eligible to enroll in our comprehensive benefits package, which includes medical, dental, vision, short and long-term disability, life and supplemental life insurance, and PTO.

     

    All employees are eligible to enroll in our company matched 401(k) plan.

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed