The Pharmacy Billing Representative is responsible for ensuring timely and accurate billing of unbilled claims and securing payment for outstanding balances. This role requires excellent customer service skills when interacting with patients, healthcare professionals, and insurance carriers.
The representative will work across multiple operating systems and web-based applications to retrieve document images, gather supporting or additional information related to pharmacy fills, and process claims through resolution. The role is responsible for maintaining compliant, timely, and accurate billing practices.
Key Responsibilities
Process and resolve unbilled pharmacy claims accurately and in a timely manner.
Follow up on outstanding balances and support account payment activities.
Review and retrieve document images and supporting information using various operating systems and web-based applications.
Gather additional information required to process and resolve claims.
Work with insurance carriers, healthcare professionals, and patients as needed.
Ensure billing activities are compliant with applicable procedures and requirements.
Prioritize daily tasks and manage workload effectively.
Maintain accurate documentation and claim information.
Provide professional and effective customer service.
Collaborate with team members to resolve billing and reimbursement issues.
Required Qualifications
Minimum 1 year of experience performing healthcare reimbursement, medical insurance/billing, or related work.
Minimum 1 year of experience working with healthcare reimbursement systems.
Working knowledge of medical terminology.
Strong customer service and communication skills.
Ability to work effectively in a team environment.
Ability to prioritize and manage daily tasks.
Experience with Microsoft Word, Excel, and Outlook.
Must be located within approximately 1 hour of the Monroeville, PA office.
Ability to work in a hybrid environment based on business requirements and performance.
Preferred Experience
Pharmacy billing experience.
Medical billing or insurance billing experience.
Healthcare reimbursement experience.
Experience working with pharmacy or healthcare claims.
Experience using multiple healthcare billing/reimbursement systems and web-based applications.