Responsable de facturación y cobranza Medical Biller

We are looking for a detail-oriented Billing Representative to support accurate and timely pharmacy billing operations.

This position is responsible for verifying insurance coverage, researching and resolving rejected claims, maintaining patient billing records, and communicating with payers and long-term care facility staff to address billing issues. The ideal
candidate is organized, responsive, and comfortable managing multiple priorities in a fast-paced environment.

KEY RESPONSIBILITIES
- Verify patient insurance eligibility and coverage with government and commercial insurance plans.
- Review daily billing reports; research, process, and resolve third-party claim rejections and denials.
- Maintain accurate, current patient demographic, billing, and insurance information in pharmacy systems.
- Prepare and submit prior authorization requests for state insurance programs, as applicable.
- Communicate regularly with insurance carriers regarding claim overrides, rejections, coverage changes, and other
billing inquiries.
- Coordinate with long-term care facility staff and relevant payer or regulatory contacts, including Medicare Part D
plans, CMS, and applicable New Jersey and New York Medicaid programs, when needed.
- Track and follow up on outstanding claims and unresolved billing issues through resolution.
- Document billing activity and communications accurately and promptly.
- Complete additional billing-related assignments as directed by the Billing Supervisor.

REQUIRED QUALIFICATIONS
- Experience handling third-party insurance claim rejections and resolutions.
- Proficiency with computers and the ability to learn pharmacy billing systems.
- Strong communication skills and a courteous, professional phone manner.
- Excellent attention to detail, organization, and follow-through.
- Ability to work independently and collaboratively while managing multiple tasks in a fast-paced setting.