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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 for Medicare and Medicaid. Proficient in managing claim rejections and facilitating communication between patients and healthcare professionals.
Highest-signal resume keywords
Medical Claims BillingNational Pharmacy Technician Certification (CPhT)Claims AdjudicationOnline Claims Processing SystemEffective Communication Skills
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 ProcessingData EntryFinancial ArrangementsPrior Authorizations
Soft Skills
CollaborationResults-OrientedEmpoweringSupportiveAptitude for Teamwork
Tools & Technologies
Claims Processing SystemPatient Portal Management
Certifications & Qualifications
National Pharmacy Technician Certification (CPhT)
Industry Keywords
CMS GuidelinesMedicareMedicaidPharmacy OperationsFinancial Assistance Programs
About the role
Key responsibilities & impact- Complete billing of pharmacy and medical claims and adjudicate rejections
- Manage claim rejections to ensure appropriate follow-up and delivery promise times are met
- Act as liaison between patients and insurance companies
- Facilitate communication between patients, doctors, medical staff, and administrative staff
- Work with payors to resolve billing issues
- Ensure Reliance Rx follows CMS guidelines per Medicare and Medicaid guidance
- Confirm billing accuracy and payor billing/shipping requirements
- Process and set up deliveries to medical offices
- Process medical claims billing for supplies and medications
- Confirm financial aspects of claims before they leave the facility
- Manage the portal, including refill reminders, portal orders, and patient registrations
- Coordinate financial assistance with patients for foundation care, copay assistance, or free medication programs
- Assist Patient Care Specialists with workflow and incoming/outgoing calls
- Maintain patient records and perform filing and documentation duties
- Perform setup and data entry
- Handle financial arrangements 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- Scorecard incentive
- Full range of benefits
- Generous paid time off