Pharmacy Billing Solutions Specialist

Pharmacy Billing Solutions Specialist - Full-Time - Remote Position Summary The Pharmacy Billing Solutions Specialist is an individual-contributor role responsible for accurate, timely billing and account resolution for Partners in Home Care's Solutions and Pharmacy services. The position serves as a subject matter resource for pharmacy billing, reimbursement, and revenue-cycle problem resolution and is dedicated to post-service work in WellSky CareTend, including charge capture, claim preparation and submission, rejection correction, accounts receivable follow-up, denial and appeal resolution, underpayment research, and billing reporting. Front-end referral intake, benefit verification, prior authorization, and pre-service financial counseling remain the responsibility of the Intake Specialist and other designated departments. The Pharmacy Billing Solutions Specialist reviews completed information only as necessary to establish billing readiness, returns incomplete items to the responsible team, and maintains clear, audit-ready billing documentation in CareTend. This position has no supervisory or lead responsibilities. Why this role matters · Dedicated billing ownership converts completed pharmacy services into accurate claims and timely reimbursement. · Clear handoffs between Intake, Pharmacy, Nursing, Delivery, and Billing reduce rework while preserving role accountability. · Strong claim follow-up, denial prevention, and root-cause analysis improve clean-claim performance, first-pass payment, and A/R results. Billing and Claims Management Review dispensing, delivery, nursing, therapy, and clinical documentation to ensure all billable drugs, supplies, services, equipment, and per diems are accurately captured. Reconcile charges against pharmacy orders, delivery records, payer requirements, fee schedules, and dates of service. Prepare, review, and submit accurate medical and pharmacy claims to Medicare, Medicaid, commercial insurance plans, workers' compensation, and other third-party payers. Validate coding, modifiers, units, authorizations, payer sequencing, and required claim documentation prior to submission. Monitor claim queues, clearinghouses, payer portals, and electronic billing systems; resolve edits, errors, and rejections within filing deadlines. Process corrected, replacement, voided, secondary, and tertiary claims as needed. Accounts Receivable and Reimbursement Follow-Up Manage unpaid, underpaid, denied, suspended, and aging claims through resolution. Research claim status through payer portals, correspondence, and telephone follow-up. Maintain accurate documentation of claim activity, payer communications, and follow-up actions. Escalate reimbursement barriers, filing-limit concerns, and complex billing issues when appropriate. Denial Management and Revenue Integrity Analyze EOBs, remittance advice, denial codes, payment variances, and rejection notices. Prepare and submit appeals, reconsiderations, and supporting documentation to secure reimbursement. Identify denial trends and recommend process improvements to reduce future claim issues. Research underpayments, refunds, recoupments, and contractual payment discrepancies. Billing Solutions and Process Improvement Investigate complex reimbursement issues and recommend compliant solutions. Maintain accurate billing records, claim statuses, payer information, and supporting documentation within WellSky CareTend. Assist with the development and maintenance of billing guides, reporting tools, clean-claim standards, and denial-prevention resources. Support revenue cycle initiatives, audits, reporting, and ongoing process improvements. Collaboration and Customer Service Work closely with Intake, Pharmacy, Nursing, Clinical, Delivery, Finance, and Revenue Cycle teams to resolve billing issues. Communicate professionally with patients, caregivers, payers, referral sources, and internal stakeholders. Provide updates regarding claim status, reimbursement concerns, and documentation needs. Compliance and Remote Work Responsibilities Maintain compliance with HIPAA, Medicare, Medicaid, CMS, OIG, payer regulations, and company policies. Protect confidential patient and financial information in all work activities. Maintain a secure, HIPAA-compliant remote work environment. Meet established productivity, quality, accuracy, and customer service expectations.