Make a difference in the lives of the nation's veterans by supporting pharmacy billing operations for HMR Veterans Services.
The Pharmacy Billing Specialist is responsible for administering the day-to-day functions of pharmaceutical billing in accordance with applicable federal, state, and local standards, guidelines, and regulations. This role supports billing operations across all payer sources and works closely with the Billing Manager and Director of Operations.
Key duties include:
- Completing administrative requirements such as forms and reports
- Maintaining productive working relationships with facility personnel to support documentation completion
- Charging, recording, and billing on a monthly basis
- Entering billing data and setting up resident files
- Addressing prior authorization and formulary exception issues
- Monitoring pharmacy electronic claims logs to ensure accurate billing
- Tracking prior authorizations to help ensure payment
- Preparing and sending statements
- Tracking and reporting reconciliation payments
- Managing pharmacy aging in QS1 and following up on outstanding accounts
- Supporting pharmacy contract and provider agreement efforts
- Providing financial statements and required monthly financial data
- Ensuring pharmacy auditing information is addressed promptly and accurately
- Performing other related duties as assigned
Requirements & Qualifications
Qualifications
- High school diploma or equivalent required
- At least 1 year of Pharmacy Technician experience or equivalent QS1 pharmacy processor knowledge and billing experience
- Prior pharmaceutical experience preferred
- Knowledge of computer systems, system applications, and related equipment
- Strong knowledge of pharmacy billing laws, regulations, and guidelines in long-term care settings
- Understanding of general pharmacy terminology, brand and generic medication names, and general medical terminology
- Detailed knowledge of pharmacy insurance procedures
- Ability to make independent decisions when needed
- Ability to work tactfully with staff, residents, families, visitors, government personnel, and the public
- Ability to maintain confidentiality of medical and personal information
- Must be able to work independently and with flexibility, personal integrity, and professionalism
- Ability to cope with the mental and emotional demands of the position
Benefits & Perks
Benefits and perks
- 401(k) with company match
- Medical insurance
- Dental insurance
- Vision insurance
- Employee Assistance Program (EAP)
- Paid time off (PTO)
- Tuition reimbursement program
- Company-paid life insurance
- Career growth opportunities
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
3 weeks ago