Polaris Pharmacy Services

Role Description The Billing Specialist is responsible for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements. - Process third-party billing, claim resolution, and adjudication - Manage FFS and PPS billing - Conduct census balancing and payor verification - Verify insurance and Medicaid coverage - Knowledge of Dual Coverage, MCR D, and Commercial Plans pertaining to Long Term Care - Assist with all customer billing inquiries in a courteous and professional manner - Enter fees and charges in Framework LTC - Prepare daily, weekly, and monthly pre-bills and account audits - Prepare daily, weekly, and monthly reports - Create statements and EOM summaries - Understand and work with residents on account balances - Follow all applicable government regulations including HIPAA - Other duties as deemed necessary by Billing Manager Qualifications - Able to read, write, speak, and understand the English language - Able to work in a fast-paced environment - Basic computer knowledge skills required - Basic math and analytical skills - Proficient in Microsoft Word, Excel, and Outlook required - Good organization/Attention to detail - Able to work at a moderate speed - Reliable - Problem solver - Able to work various shifts and days - Adaptability to an ever-changing environment Requirements - High School diploma or equivalent required - Two (2) years’ pharmacy billing experience required (long-term care preferred) - Framework LTC & General computer knowledge & 10-key Number Entry preferred - Knowledge of Sage preferred Physical Demands - May sit or stand seven (7) to ten (10) hours per day - The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk - May be necessary to work extended hours as needed - May lift and/or move up to 30 pounds - The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role Benefits - Medical, Dental, and Vision insurance - 401 (k) (available for Part Time & Full Time EEs) - Company Paid Life insurance - Short-term and Long-term disability insurance - Tuition reimbursement - Personal Time Off (PTO) - Competitive pay with annual performance reviews and merit-based raises - Career growth potential - Annual on-site voluntary Flu Vaccines - Employee referral bonus program

Role Description The Medicaid Pending Billing Specialist at POLARIS PHARMACY SERVICES is responsible for managing the billing process for Medicaid pending claims, ensuring timely resolution and rebilling. This role requires a detail-oriented professional who can effectively liaise with various stakeholders to facilitate appeals and provide financial assistance, while maintaining accurate documentation throughout the process. - Manage the pending queue for Medicaid claims, ensuring all claims are processed efficiently and accurately. - Resolve claim issues by identifying discrepancies and implementing solutions to facilitate timely payments. - Rebill Medicaid claims as necessary, ensuring compliance with relevant regulations and guidelines. - Serve as a liaison between POLARIS PHARMACY SERVICES and Medicaid representatives, facilitating communication and resolution of billing issues. - Handle appeals processes, working to overturn denied claims and secure payment. - Provide financial assistance guidance to patients and families, helping them navigate the complexities of Medicaid billing. - Maintain thorough and accurate documentation of all billing activities, ensuring records are up-to-date and accessible for auditing and reporting purposes. Qualifications - Strong knowledge of Medicaid billing procedures and regulations. - Excellent organizational skills with the ability to manage multiple tasks and priorities effectively. - Proficiency in using billing software and Microsoft Office Suite, including Excel and Word. - Strong analytical skills with attention to detail in documentation and claim resolution. - Effective communication skills to liaise with various stakeholders, including patients, insurance companies, and internal departments. - Ability to work independently and collaboratively in a fast-paced environment. - Problem-solving skills with a proactive approach to resolving billing issues and claims efficiently. Requirements - High school diploma or equivalent; an associate or bachelor's degree in healthcare administration, finance, or a related field is preferred. - Minimum of 2 years of experience in medical billing, preferably with Medicaid. - Proven experience in managing pending queues and resolving claims. - Experience in working with financial assistance programs and understanding of appeals processes. Benefits - Medical, Dental, and Vision insurance. - 401 (k) (available for Part Time & Full Time EEs). - Company Paid Life insurance. - Short-term and Long-term disability insurance. - Tuition reimbursement. - Personal Time Off (PTO). - Competitive pay with annual performance reviews and merit-based raises. - Career growth potential. - Annual on-site voluntary Flu Vaccines. - Employee referral bonus program.

Role Description As a Collections Specialist, you will be responsible for monitoring the receivables on patient accounts in a long-term care setting. This role is essential to ensuring patient financial services are handled properly. This position is responsible for helping patients understand their pharmaceutical charges and assist in resolving any resident questions or concerns. Duties/Responsibilities - Collect information and verify account-specific billing, insurance, and coding. - Update and document customer accounts designated in the work campaign. - Verify the accuracy of existing account standing and progress accounts accordingly. - Resolve client-billing problems, rescue accounts receivable delinquency, and apply good customer service in a timely manner. - Identify issues attributing to account delinquency and forward issues to appropriate department. - Obtain primary financial data for accounting records. - Check the accuracy of business transactions. - Perform data entry and administrative duties. - Work in conjunction with outside collection agencies. - Conduct outbound calls to reconcile account issues and outstanding account balances. - Ensure compliance through strict adherence to federal and state laws, as well as company policy. - Payment processing and post follow-up. Qualifications - Able to read, write, speak, and understand the English language. - Able to work in a fast-paced environment. - Basic computer knowledge skills required. - Basic math and analytical skills. - Proficient in Microsoft Word, Excel, and Outlook required. - Good organization/Attention to detail. - Able to work at a moderate speed. - Reliable. - Problem solver. - Able to work various shifts and days. - Adaptability to an ever-changing environment. Requirements - High School diploma or equivalent required. - Two (2) or more years of corporate collections work experience, including interaction with a large customer base. - Knowledge of pharmacy operations systems preferred. Physical Demands - May sit or stand seven (7) to ten (10) hours per day. - The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk. - May be necessary to work extended hours as needed. - May lift and/or move up to 30 pounds. - The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role. Benefits - Medical, Dental, and Vision insurance. - 401 (k) (available for Part Time & Full Time EEs). - Company Paid Life insurance. - Short-term and Long-term disability insurance. - Tuition reimbursement. - Personal Time Off (PTO). - Competitive pay with annual performance reviews and merit-based raises. - Career growth potential. - Annual on-site voluntary Flu Vaccines. - Employee referral bonus program.

Job DetailsJob Location: Polaris Pharmacy Services of Ft Lauderdale - Ft. Lauderdale, FL 33309Position Type: Full TimeJob Category: PharmaceuticalPRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE At Polaris Pharmacy Services, we’re more than a pharmacy — we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we’re raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support. Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job — we provide competitive pay, robust benefits, and genuine opportunities for career advancement. If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect. RESPONSIBILITIES Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement Contact providers and/or customers as necessary to obtain additional information Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes Work as a team to identify, document, communicate, and resolve payer/billing trends and issues Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner Review and work convert billing exception reports to ensure claims are billed to accurate financial plans Complete billing transactions for non-standard order entry situations as required Support training needs Prepare and maintain reports and records for processing Perform other tasks as assigned. Follow all applicable government regulations, including HIPAA Comply with departmental policies regarding safety, attendance, and dress code Overtime, holidays, and weekends may be required and/or expected Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards Other duties as assigned; Job duties may vary depending on business needs QualificationsQUALIFICATIONS High School diploma or equivalent required Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred) Framework LTC & General computer knowledge & 10-key Number Entry preferred Able to read, write, speak, and understand the English language Able to retain a large amount of information and apply that knowledge to related situations Able to work in a fast-paced environment Basic computer knowledge skills required Basic math and analytical skills Experience with alpha-numeric data entry Proficient in Microsoft Word, Excel, and Outlook required Customer Service Results-oriented Good organization/Attention to detail Reliable Problem solver Able to work various shifts and days Adaptability to an ever-changing environment PHYSICAL DEMANDS The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job: May sit or stand seven (7) to ten (10) hours per day The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently May be necessary to work extended hours as needed May lift and/or move up to 50 pounds The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role HOLIDAY & PTO POLICY Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days. Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses. Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility. Please note we are a long-term care pharmacy open 24-hours a day, 7 days a week. And schedules may change as determined by the needs of the business. BENEFITS for full time employees Medical, Dental, and Vision insurance 401 (k) (available for Part Time & Full Time EEs) Company Paid Life insurance Short-term and Long-term disability insurance Tuition reimbursement Personal Time Off (PTO) Competitive pay with annual performance reviews and merit-based raises Career growth potential Annual on-site voluntary Flu Vaccine Employee referral bonus program