Guardian Pharmacy · 17 hours ago
Billing Specialist (Healthcare)
Englewood, Colorado
Full-time
Onsite
Entry, Mid Level
$21/hr - $25/hr
2+ years expGuardian Pharmacy is one of the nation’s largest long-term care pharmacy services providers, offering innovative medication management solutions. The Billing Specialist role involves managing prescription insurance claims, processing patient payments, and maintaining excellent customer service while ensuring compliance with billing requirements.
Assisted LivingElder CareHealth CareNursing and Residential Care
Responsibilities
Manage and resolve prescription insurance claims, including rejections, eligibility issues, and prior authorizations
Correct, rebill, and follow claims through to successful reimbursement
Process patient payments, credits, returns, and credit card transactions accurately and securely
Support pharmacy operations by applying healthcare and pharmacy billing expertise
Follow up on delinquent accounts and work with patients to establish payment arrangements while maintaining excellent customer service
Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month-end billing functions, procedures and reporting
Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed. Make corrections as needed and rebill claims as necessary
Process patient payments, returns, and credits. Transmit individual credit card payments as needed
May pursue payment from delinquent accounts and make payment arrangements
Research and establish patient eligibility coverage with insurance providers including private individuals and/or government entities. Reverify benefit coverage criteria as needed for claims follow up. Accurately enters and/or updates patient/insurance information into billing system
Maintain and continually audit patient files and corresponding documentation necessary to defend third party audits and ensure payer and company compliance. Accurately enter patient information into the pharmacy system
Provide assistance and timely response to all billing customer inquiries via phone or electronic communications. Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits. Uses working knowledge to troubleshoot and resolve customer service issues
Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods. Proactively review patient profiles, drug regimens and insurance coverage to evaluate options to save resident money
Research, identify and organize requested audit documentation in timely manner
Through prior experience and cross training, demonstrate knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) and working/functional knowledge of other pharmacy departmental functions
Exercise proficiency in the utilization of pharmacy information systems to meet operational needs and regulatory requirements. This includes using pharmacy systems to process prior authorizations, resolve rejections, produce various reports as necessary, and complete billing functions in a timely manner and with a high degree of accuracy
Consistently meet pharmacy's established accuracy and productivity levels
Follow all applicable government regulations including HIPAA
Work as a collaborative team member to meet the service goals of the pharmacy
Other essential functions and duties may be assigned as needed
Qualification
Required
Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
Relational – ability to build relationships with business unit management and become 'trusted advisor.'
Strategy and Planning – ability to think ahead, plan and manage time efficiently
Problem Solving – ability to analyze causes and solve problems at functional level
Team Oriented – ability to work effectively and collaboratively with all team members
High School Diploma or GED required
Pharmacy Technician license/certification/registration per state requirements; National Certification preferred (PTCB) may be required (pharmacy specific)
2 + years related experience including a minimum of 6 months billing experience in long term care or retail setting
Advanced computer skills; pharmacy information system experience required
Ability to work independently and deliver to deadlines
Great attention to detail and accuracy
Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines
Quality minded; motivated to seek out errors and inquire about inaccuracies
Preferred
Proven experience as a healthcare billing specialist, ideally within a pharmacy setting
Pharmacy Technician license preferred
Strong working knowledge of insurance adjudication, third-party payers, and pharmacy billing systems
Detail-oriented with the ability to independently manage complex billing issues from start to resolution
Benefits
401(k) with company match
Medical, Dental and Vision
Health Savings Accounts and Flexible Spending Accounts
Company-paid Basic Life and Accidental Death & Dismemberment
Company-paid Long-Term Disability and optional Short-Term Disability
Voluntary Employee and Dependent Life, Accident and Critical Illness
Dependent Care Flexible Spending Accounts
Employee Assistance Program (EAP)
Guardian Angels (Employee assistance fund)
Paid holidays and sick days
Generous vacation benefits based on years of service
Company
Guardian Pharmacy
Guardian Pharmacy offers medication management services for long-term pharmacy care.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$217.5MKey Investors
Regions Bank
2025-05-22Post Ipo Secondary· $157.5M
2024-09-26IPO
2018-07-16Debt Financing· $60M
Leadership Team
Doug Towns
Vice President, General Counsel & Senior Compliance Officer
Jeff Tuch
VP - Purchasing & Pricing Analytics
Recent News
2026-01-15
2025-11-11
2025-11-11
Company data provided by crunchbase