Job Summary

The Insurance & Claims Billing Specialist will be responsible for processing pharmacy claims, resolving denials, submitting prior authorizations, and managing insurance verifications for BaRupOn's retail and compounding pharmacy operations. This associate-level role requires attention to detail, familiarity with third-party billing systems, and strong communication with patients, payors, and internal teams.

Key Responsibilities

• Submit prescription claims and ensure accuracy in billing data entry
• Verify insurance coverage for new prescriptions and compounding services
• Investigate and resolve rejections, claim denials, and payment discrepancies
• Coordinate with prescribers for prior authorization documentation
• Maintain up-to-date knowledge of payor formularies, billing codes, and compliance rules
• Communicate with patients regarding copays, authorizations, and insurance updates
• Assist with patient account reconciliation and documentation audit support
• Ensure timely filing and rebilling of claims according to deadlines

Qualifications

• Associate degree or relevant certification in Medical Billing, Health Administration, or Pharmacy Technology
• 2–3 years of experience in pharmacy billing or healthcare insurance claims
• Familiarity with NCPDP standards, PBM platforms, and Medicare/Medicaid billing processes
• Proficient in pharmacy software systems (e.g., PioneerRx, QS/1, FrameworkLTC)
• Strong organizational, data entry, and communication skills
• Knowledge of HIPAA and healthcare billing compliance requirements

Preferred Skills

• Experience working in a compounding or specialty pharmacy
• Certified Pharmacy Technician (CPhT) or Certified Medical Reimbursement Specialist (CMRS)
• Understanding of 340B programs or third-party payor policies
• Bilingual preferred (English/Spanish or English/Mandarin)

Benefits

• Health, dental, and vision insurance
• 401(k) with employer match
• Paid time off and holidays
• Continuing education and certification support
• Opportunities for advancement in revenue cycle or pharmacy operations