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Billing Supervisor - Adjudication

Company: Guardian PHarmacy, LLC
Location: Kernersville
Posted on: September 16, 2023

Job Description:

Kernersville, North Carolina, United States of America

Southern Pharmacy Services is part of the Guardian Pharmacy Services network and prides itself on its customer service. Each team member plays an integral part in the success of the pharmacy.Schedule: Full Time, Monday-Friday 8a-5p, with a weekend rotation.This role will be performed onsite at our closed-door pharmacy in Kernersville, NC. - All patient interactions will be over the phone.We Offer:

  • Comprehensive training provided side by side with training team.
  • Must be comfortable working in a high-volume environment.
  • We offer full time benefits including health, vision, dental and matching 401k options.Support the team with all billing/collections functions and ensure they are performed in a timely and accurate manner. Ensure all relevant input is complete, accurate, and fully adjudicated to ensure margin is maximized. Responsible for the integrity of all batches and their timely posting. Handle escalated billing issues and make sure full customer satisfaction is reached for residents, responsible parties and facility staff. Work with other departments as it relates to billing and claims adjudication.Attributes Required:--- Work Ethic/Integrity - must possess intrinsic drive to excel coupled with values in line with company philosophy--- Leadership - ability to lead project teams to deadlines, while maintaining strong team orientation--- 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 both a strategic and functional level--- Team Oriented - ability to work effectively and collaboratively with all team membersEssential job functions (include the following):--- Manage billing, A/R, and collection functions to ensure high level of customer service is maintained; manage productivity to metrics to include production & error rates--- Supervise team members, to include: hiring, training, evaluating, scheduling, coaching, disciplining, etc.--- Lead team in development and ongoing updates for all operations training manuals to assist in new employee training process; ensure written policies and procedures are maintained and updated for each area/function--- Assist in month end close processes, including statement prep, analysis reports, etc.--- Provide analysis of operational reports such as unbilled revenue; provide detailed explanation of variances and corrections--- Lead and participate in regular team meetings for direct reports and coordinate multi-department meetings to ensure good communication and issue resolution; participate and lead discussions as requested for operational meetings--- Serve as subject matter expert on all department operating systems and programs, including QS/1, DocuTrack, banking software, and others, in order to provide assistance and analysis to department--- Ensure all claims are adjudicated and batches composited and/or posted in a timely manner--- Ensure the PA/rejection queue is updated and resolved in a timely manner--- Quality check all patient and insurance information data entered in the system--- Have a thorough working knowledge of all department functions in order to assist/support clearing bottlenecks in workflow and ensuring the most efficient processes are followed--- Assist in answering phones and providing customer service--- Provide customer account audits when occasions arise--- Become cross trained in all areas of department function so as to assist in clearing bottlenecks in work flow--- Lead by example in all areas of role and supporting the non-negotiable attributes: attitude, dependability, commitment, productivity, efficiency and upholding policies and procedures--- Other essential functions and duties may be assigned as neededEducation and/or Certifications:--- High School Diploma or GED required; Bachelor's Degree preferred--- Pharmacy Technician license/certification/registration (per state requirements); National Certification preferred (PTCB) may be required (pharmacy specific)Skills and Qualifications:--- 5+ years of related experience (advanced degree may substitute for experience); at least 3 years in high volume claims processing field--- Advanced computer skills; pharmacy operations system experience preferred/required--- Ability to work independently and deliver to deadlines--- Ability to solve problems with minimal direction--- 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 when something appears inaccurateWork Environment:--- Ability to work flexible hoursFull-Time employees working 30+ hours per week are eligible to enroll in our comprehensive benefits package, which includes medical, dental, vision, short and long-term disability, life and supplemental life insurance, and PTO.All employees -are eligible to enroll in our company matched 401(k) plan.

Keywords: Guardian PHarmacy, LLC, Winston-Salem , Billing Supervisor - Adjudication, Accounting, Auditing , Kernersville, North Carolina

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