Sr. Billing Specialist

Job Description

Job Description

Sr. Pharmacy Billing Specialist

We are partnering with a well-established long term care pharmacy organization in Phoenix that is looking for a Senior Pharmacy Billing Specialist. This is a great opportunity for someone who knows the pharmacy billing world, enjoys solving claim and coverage issues, and wants to be part of a stable, service focused team where accuracy and follow through are highly valued.

What You'll Do

In this role, you will support daily and month end billing activity, process insurance claims, resolve billing issues, and serve as a knowledgeable resource for the team. You will work closely with internal departments, patients, families, caregivers, medical providers, and insurance carriers.

Key responsibilities include:

• Verify patient insurance eligibility and benefits across commercial, Medicare, Medicaid, and other government plans
• Review and confirm coverage details to support accurate claims processing and reimbursement
• Maintain accurate patient, insurance, and billing records within pharmacy systems
• Audit patient files and documentation to support compliance and third-party audit requirements
• Research and resolve billing questions related to coverage, eligibility, benefits, claims, and balances
• Help residents and families understand Medicare plan options and identify ways to reduce out of pocket costs
• Manage daily census updates for assigned facilities, including admissions, discharges, and room changes
• Process payments, refunds, credits, and credit card transactions accurately and on time
• Follow up on outstanding balances and help coordinate payment arrangements when appropriate
• Prepare and organize documentation for audits within required timelines
• Adjudicate prescription claims and resolve rejections, prior authorizations, eligibility issues, and rebilling needs
• Apply knowledge of pharmacy billing workflows, Medicare, Medicaid, PDPs, and third party payer requirements
• Serve as a subject matter resource for billing systems, reporting, claims resolution, and department workflows
• Maintain strong standards for accuracy, productivity, communication, and service
• Follow HIPAA guidelines and all applicable regulatory requirements
• Partner with team members to support pharmacy service goals and overall department success

What They're Looking For

The right person for this role is detail oriented, dependable, and comfortable working through billing issues that require patience, judgment, and follow through. You do not need to be the loudest person in the room, but you should be someone others trust when accuracy matters.

Qualifications include:

• High school diploma or GED required.
• Pharmacy technician license, certification, or registration required based on state guidelines
• PTCB certification preferred where applicable
• 3 or more years of related pharmacy billing, healthcare billing, or insurance claims experience
• Prior experience in a senior billing specialist, billing specialist II, or similar lead level capacity preferred
• Strong working knowledge of pharmacy systems and billing software
• Experience with Medicare, Medicaid, PDPs, third party payers, claim rejections, prior authorizations, and rebilling
• Strong attention to detail and commitment to accuracy
• Ability to work independently, meet deadlines, and manage competing priorities
• Strong problem-solving skills and sound judgment
• Clear written and verbal communication skills
• Professional, patient, and service-oriented approach when responding to inquiries
• Ability to build trust with internal teams, patients, families, providers, and insurance contacts
• High integrity, strong follow through, and a team focused mindset

Schedule and Location

This is a full-time, on-site position based in Phoenix, Arizona.