Pharmacy Billing Specialist
On-site · Chicago, Illinois, United States
Job Summary
The Pharmacy Billing Specialist will oversee pharmacy revenue cycle operations, third-party billing, audits, and compliance for ambulatory pharmacy services. Responsibilities include standardizing and optimizing insurance benefit verification, prior authorization preparation/submission, and appeals; submitting accurate claims using HCPCS/CPT codes and modifiers; managing denials and underpayments; overseeing charge capture, billing workflows, and collections; coordinating with payors and internal stakeholders; conducting audits to ensure HIPAA and payer-contract compliance; preparing audit reports and action plans; supporting external payer reviews; monitoring regulatory changes; developing training modules on billing, audits, and compliance; and acting as a subject-matter expert on pharmacy billing and revenue cycle improvements.
Required Qualifications
- Associate degree required
- 5 years’ pharmacy experience in a progressive, complex healthcare environment
- Hands-on experience with claims processing, denial management, prior authorizations, and compliance audits
- Experience with 340B programs, HCPCS/CPT coding, and payer-specific guidelines (Medicare, Medicaid, commercial insurers)
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