Pharmacy Billing Specialist - Sacramento, CACompensation: $20 - $25 HourlyOverview: Nexus HR is looking for a Pharmacy Billing Specialist with strong experience working in a fast-paced Long-Term Care and Assisted Living pharmacy in Sacramento.About the Job:The Pharmacy Billing Specialist is responsible for managing and processing all aspects of third-party billing, claims submission, and reimbursement for a long-term care and assisted living pharmacy. This role ensures accurate claim adjudication, timely payment posting, and resolution of billing discrepancies while maintaining compliance with federal, state, and payer-specific guidelines.Duties and Responsibilities:Accurately prepare, submit, and track insurance claims for medications dispensed to long-term care and institutional patients.Verify insurance eligibility, coverage details, and prior authorizations as required.Resolve claim rejections, denials, and underpayments by communicating with payers, facilities, and internal teams.Post payments, reconcile accounts, and ensure accurate patient/resident billing records.Maintain compliance with Medicare, Medicaid, and private insurance billing regulations.Collaborate with pharmacy staff, prescribers, and nursing facilities to address billing-related issues.Generate billing reports and assist with audits to ensure accuracy and compliance.Respond to inquiries from facilities, patients, or family members regarding billing questions in a professional and timely manner.Support process improvements to enhance billing accuracy, efficiency, and reimbursement outcomes.Qualifications:High school diploma or equivalent required; Associate degree in healthcare administration, accounting, or related field preferred.Minimum 1 year of pharmacy billing, medical billing, or related healthcare billing experience; LTC pharmacy experience strongly preferred.In-depth knowledge of insurance requirements.Strong proficiency in pharmacy billing software and Microsoft Office Suite.Excellent analytical, organizational, and problem-solving skills.Strong communication skills with the ability to interact professionally with healthcare providers and facility staff.High attention to detail and accuracy in data entry and financial reconciliation.
