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Billing Specialist
Independent Health. Complete billing of pharmacy and medical claims and adjudicate rejections .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims billing and adjudication, ensuring compliance with CMS guidelines and effective communication with patients and healthcare professionals. Proficient in managing claim rejections and coordinating financial assistance programs.
Highest-signal resume keywords
Medical Claims BillingNational Pharmacy Technician Certification (CPhT)Claims Processing System ExperienceEffective Communication SkillsPatient Record Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Billing AccuracyClaims AdjudicationData EntryFinancial CoordinationPrior Authorization Assistance
Soft Skills
CollaborationResults-OrientedEmpoweringSupportiveCommunication
Tools & Technologies
Patient Portal ManagementOnline Claims Processing System
Certifications & Qualifications
National Pharmacy Technician Certification (CPhT)
Industry Keywords
CMS GuidelinesMedicareMedicaidPharmacy OperationsHealthcare Professionals
About the role
Key responsibilities & impact- Complete billing of pharmacy and medical claims and adjudicate rejections
- Manage claim rejections and ensure appropriate follow-up and delivery promise times are met
- Act as a liaison between patients and insurance companies
- Facilitate communication between patients, doctors, medical staff, and administrative staff
- Work with payors to resolve billing issues
- Ensure compliance with CMS guidelines and Medicare and Medicaid guidance
- Confirm billing accuracy and payor billing/shipping requirements
- Process and set up deliveries to medical offices
- Perform medical claims billing for supplies and medications
- Confirm financial aspects of claims before they leave the facility
- Manage the patient portal, including refill reminders, portal orders, and patient registrations
- Coordinate financial assistance for foundation care, copay assistance, and free medication programs
- Assist Patient Care Specialists with workflow and incoming and outgoing calls
- Maintain patient records and perform filing and documentation duties
- Perform setup and data entry
- Arrange finances and collect co-payments
- Assist offices with prior authorizations
- Coordinate benefits
- Promote information sharing and continuous process improvement
- Follow standard written procedures and guidelines, with deviations approved by the supervising pharmacist
Requirements
What you’ll need- High school diploma or GED required
- National Pharmacy Technician Certification (CPhT) preferred
- One (1) year of experience working in a high-volume pharmacy, or equivalent setting, required, or six (6) months as a temporary associate in the Reliance Rx Operations & Compliance department
- Experience working with online claims processing system preferred
- Effective oral and written communication skills
- Aptitude for working with other health care professionals
- Ability to lift a minimum of 5 lbs
- Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive
- Immigration or work visa sponsorship will not be provided for this position
Benefits
Comp & perks- Shift differential for evening hours after 6pm
- Scorecard incentive eligibility
- Full range of benefits
- Generous paid time off
- Hybrid work arrangement after onsite training