Specialist, Pharmacy Billing Resolution

Description

The Specialist, Pharmacy Billing Resolution researches and resolves customer billing inquiries, audits, disputes, invoice discrepancies, credit requests, and related account issues. The role serves as a liaison between Billing and Pharmacy Operations to determine what occurred operationally, validate charges, identify appropriate corrective action, and ensure resolutions are supported by accurate documentation. This position reviews dispensing activity, delivery records, returns, credits, census changes, medication changes, payer information, facility communications, and other relevant records to identify the root cause of billing discrepancies and help prevent recurring issues.

Job Responsibilities

• Review and resolve customer billing audits, disputes, account discrepancies, and credit requests.
• Research dispensing records, deliveries, returns, credits, census activity, payer information, and other operational documentation.
• Determine whether disputed charges are supported and identify appropriate credits, adjustments, rebills, or corrections.
• Identify the operational root cause of billing discrepancies and recurring trends.
• Maintain clear and accurate documentation supporting findings and resolutions.
• Partner with Billing, Pharmacy Operations, Customer Service, Finance, and facility representatives to resolve issues.
• Track open billing issues and audits through completion and follow up on outstanding items.
• Escalate high-dollar, recurring, unusual, or unresolved discrepancies to management.
• Recommend process, system, or training improvements that may reduce repeat billing issues.
• Maintain confidentiality and comply with applicable pharmacy, billing, HIPAA, and company requirements.
• Maintain predictable, reliable, and punctual attendance and perform other related duties as assigned.

Requirements

Basic Qualifications

• High school diploma or GED and at least 2 years of related experience in pharmacy operations, pharmacy or PBM billing, accounts receivable, customer account management, or a related healthcare environment; equivalent education and experience considered.
• Pharmacy technician registration or licensure where required by state law or assigned responsibilities.
• Strong analytical, investigative, organizational, and problem-solving skills, with the ability to independently research, reconcile, and resolve recurring billing discrepancies.
• Intermediate proficiency with Microsoft Excel and pharmacy, billing, medication distribution, or related healthcare systems.
• Ability to read and interpret medication documentation, reports, business correspondence, and procedures and communicate findings effectively in writing and verbally.
• Ability to perform basic calculations involving rates, ratios, percentages, decimals, and account balances and interpret reports, charts, and data.

Preferred Qualifications

• Associate degree, bachelor’s degree, or relevant technical or pharmacy credential.
• Certified Pharmacy Technician (CPhT).
• Long-term care or closed-door pharmacy experience.
• Experience with pharmacy claims, credits, audits, billing resolution, or long-term care pharmacy software.